Provider Demographics
NPI:1285782755
Name:EDMONDSON, PAMELA KAY (LPCC, LADAC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAY
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:LPCC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 SAN MATEO BLVD NE
Mailing Address - Street 2:SUITE W11B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4058
Mailing Address - Country:US
Mailing Address - Phone:505-232-3000
Mailing Address - Fax:
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE W11B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4058
Practice Address - Country:US
Practice Address - Phone:505-232-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0087351101YP2500X
NM0090351101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)