Provider Demographics
NPI:1194431734
Name:PAMELA PEROS-HENDERSON
Entity type:Organization
Organization Name:PAMELA PEROS-HENDERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEROS-HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-222-7292
Mailing Address - Street 1:6605 ABERCORN ST STE 11F
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5815
Mailing Address - Country:US
Mailing Address - Phone:808-222-7292
Mailing Address - Fax:
Practice Address - Street 1:6605 ABERCORN ST STE 11F
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5815
Practice Address - Country:US
Practice Address - Phone:808-222-7292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW005822OtherLCSW