Provider Demographics
NPI:1053552190
Name:PAMELA LIVINGSTON LMSW,ACSW
Entity type:Organization
Organization Name:PAMELA LIVINGSTON LMSW,ACSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW,ACSW
Authorized Official - Phone:248-840-1919
Mailing Address - Street 1:316 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2726
Mailing Address - Country:US
Mailing Address - Phone:248-840-1919
Mailing Address - Fax:248-548-4944
Practice Address - Street 1:316 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2726
Practice Address - Country:US
Practice Address - Phone:248-840-1919
Practice Address - Fax:248-548-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010177091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty