Individual provider · Type 1 NPI

Pamela Ennis, CATC - IV - 167423IV

Addiction (Substance Use Disorder) Counselor · Lynwood, CA

NPI number 1093967655 Active

Practice location

11315 Atlantic Ave
Lynwood, CA 90262-3007

Call (310) 537-5883 Map

Mailing address

270 W 14th St
San Pedro, CA 90731-4315

Specialties and licenses

TaxonomyCodeLicense
Case Management Agency 251B00000XNone listed
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

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About NPI 1093967655

Pamela Ennis, CATC - IV - 167423IV's National Provider Identifier is 1093967655, issued on Oct 15, 2008. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Lynwood, CA. The record was last updated on Jun 8, 2017.