Provider Demographics
NPI:1124135868
Name:GARDNER, PAMELA DILLARD (CSCA CCS)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DILLARD
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CSCA CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 ASHELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4023
Mailing Address - Country:US
Mailing Address - Phone:828-398-2251
Mailing Address - Fax:828-254-1524
Practice Address - Street 1:90 ASHELAND AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4023
Practice Address - Country:US
Practice Address - Phone:828-398-2251
Practice Address - Fax:828-254-1524
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1110101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6110565Medicaid
NC145XHOtherBLUECROSS BLUESHIELD OF NORTH CAROLINA