Provider Demographics
NPI:1992083505
Name:BARCKHOLTZ, PAMELA ROSE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ROSE
Last Name:BARCKHOLTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 GRASS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-2305
Mailing Address - Country:US
Mailing Address - Phone:248-563-0930
Mailing Address - Fax:248-887-1894
Practice Address - Street 1:5555 GRASS LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383-2305
Practice Address - Country:US
Practice Address - Phone:248-563-0930
Practice Address - Fax:248-887-1894
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010346221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical