Provider Demographics
NPI:1114114725
Name:TOMBERLIN, PAMELA S (LPC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:TOMBERLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 B MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382
Mailing Address - Country:US
Mailing Address - Phone:361-729-0633
Mailing Address - Fax:361-790-8527
Practice Address - Street 1:802 B MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382
Practice Address - Country:US
Practice Address - Phone:361-729-0633
Practice Address - Fax:361-790-8527
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721P101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional