Provider Demographics
NPI:1124266879
Name:MORAN-CHRISTNER, PAMELA JEAN (RN, LPC, LSATP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:MORAN-CHRISTNER
Suffix:
Gender:F
Credentials:RN, LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WINSOME HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:VA
Mailing Address - Zip Code:23696-2322
Mailing Address - Country:US
Mailing Address - Phone:757-873-1958
Mailing Address - Fax:757-873-1958
Practice Address - Street 1:708 MOBJACK PL
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1957
Practice Address - Country:US
Practice Address - Phone:757-873-1958
Practice Address - Fax:757-873-2143
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000221101YA0400X
VA0701003390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124266879Medicaid