Basic Information
Provider Information
NPI: 1275666851
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAUGH
FirstName: PAMELA
MiddleName: C.
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 895 STATE FARM RD
Address2: SUITE 508
City: BOONE
State: NC
PostalCode: 286074917
CountryCode: US
TelephoneNumber: 8282649007
FaxNumber: 8282625687
Practice Location
Address1: 1430 WILLOW LN
Address2: WEST PARK C61-2
City: NORTH WILKESBORO
State: NC
PostalCode: 286593551
CountryCode: US
TelephoneNumber: 3366675151
FaxNumber: 8282625687
Other Information
ProviderEnumerationDate: 03/13/2007
LastUpdateDate: 07/09/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XC005972NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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