Provider Demographics
NPI:1861107013
Name:RAINEY, PAMELA DANIEL
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DANIEL
Last Name:RAINEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:BELLE ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70341-5135
Mailing Address - Country:US
Mailing Address - Phone:225-810-7992
Mailing Address - Fax:
Practice Address - Street 1:2590 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5843
Practice Address - Country:US
Practice Address - Phone:985-313-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health