Provider Demographics
NPI:1962988576
Name:PAMS PLACE COUNSELING CENTER
Entity type:Organization
Organization Name:PAMS PLACE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:LLPC
Authorized Official - Phone:313-894-8088
Mailing Address - Street 1:2441 W GRAND BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1229
Mailing Address - Country:US
Mailing Address - Phone:313-894-8088
Mailing Address - Fax:313-894-8888
Practice Address - Street 1:2441 W GRAND BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1229
Practice Address - Country:US
Practice Address - Phone:313-894-8088
Practice Address - Fax:313-894-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007590101YP2500X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty