Provider Demographics
NPI:1104230911
Name:CREED, PAMELA GAIL (LICDC-CS)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GAIL
Last Name:CREED
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 STATE ROUTE 728
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45699-0001
Mailing Address - Country:US
Mailing Address - Phone:740-259-5544
Mailing Address - Fax:
Practice Address - Street 1:1724 STATE ROUTE 728
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45699-0001
Practice Address - Country:US
Practice Address - Phone:740-259-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH976041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)