Provider Demographics
NPI:1568124030
Name:DIAZ RODRIGUEZ, PAMELA (LCMHC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DIAZ RODRIGUEZ
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 OLD CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3646
Mailing Address - Country:US
Mailing Address - Phone:704-547-1483
Mailing Address - Fax:704-547-0052
Practice Address - Street 1:10001 OLD CONCORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3646
Practice Address - Country:US
Practice Address - Phone:704-547-1483
Practice Address - Fax:704-547-0052
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27715101YA0400X
NC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)