Provider Demographics
NPI:1215128533
Name:SMITH, PAMELA ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 BARBERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-8606
Mailing Address - Country:US
Mailing Address - Phone:270-692-8507
Mailing Address - Fax:
Practice Address - Street 1:145 CEMETERY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1868
Practice Address - Country:US
Practice Address - Phone:270-692-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY17841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical