Provider Demographics
NPI:1528496189
Name:DUVALLRICHARDSON, PAMELA (LAY COUNSELOR)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DUVALLRICHARDSON
Suffix:
Gender:F
Credentials:LAY COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 DURANGO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2782
Mailing Address - Country:US
Mailing Address - Phone:231-343-2753
Mailing Address - Fax:
Practice Address - Street 1:7115 DURANGO CREEK DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2782
Practice Address - Country:US
Practice Address - Phone:231-343-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171M00000X, 172A00000X, 172V00000X, 174H00000X, 372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376866160Medicaid