Provider Demographics
NPI:1104296169
Name:HOPKINS, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HOPKINS
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 1:19115 SILVERCREST ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5813
Mailing Address - Country:US
Mailing Address - Phone:248-354-3788
Mailing Address - Fax:248-354-5396
Practice Address - Street 1:1500 E STATE FAIR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-1258
Practice Address - Country:US
Practice Address - Phone:313-790-3522
Practice Address - Fax:947-282-8999
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010724751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184011769OtherMEDICARE NPI