Provider Demographics
NPI:1235951773
Name:ERVIN, PAMELA VICTORIA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:VICTORIA
Last Name:ERVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8024 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:LORIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33857-2702
Mailing Address - Country:US
Mailing Address - Phone:863-214-4652
Mailing Address - Fax:
Practice Address - Street 1:6723 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33876-5737
Practice Address - Country:US
Practice Address - Phone:863-451-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health