Provider Demographics
NPI:1194978395
Name:LIGHT, PAMELA B (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:B
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:AMEEN
Other - Last Name:BILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2421 BLACK CAP LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3027
Mailing Address - Country:US
Mailing Address - Phone:703-620-4074
Mailing Address - Fax:703-620-1969
Practice Address - Street 1:12050 S LAKES DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1220
Practice Address - Country:US
Practice Address - Phone:703-447-5171
Practice Address - Fax:703-620-1969
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040005641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical