Provider Demographics
NPI:1194058602
Name:HARRIS, PAMELA MECHELLE (INTERN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MECHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MECHELLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:INTERN
Mailing Address - Street 1:3307 BROADWAY STE 200
Mailing Address - Street 2:3307 BROADWAY, STE. 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2847
Mailing Address - Country:US
Mailing Address - Phone:916-454-4242
Mailing Address - Fax:916-454-2930
Practice Address - Street 1:3307 BROADWAY STE 200
Practice Address - Street 2:3307 BROADWAY, STE. 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2847
Practice Address - Country:US
Practice Address - Phone:916-454-4242
Practice Address - Fax:916-454-2930
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)