Provider Demographics
NPI:1578881421
Name:CARDELLA, PAMELA LASTER (LAC, LPC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LASTER
Last Name:CARDELLA
Suffix:
Gender:F
Credentials:LAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 W KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-9581
Mailing Address - Country:US
Mailing Address - Phone:318-243-2231
Mailing Address - Fax:318-450-6728
Practice Address - Street 1:1742 W KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-9581
Practice Address - Country:US
Practice Address - Phone:318-243-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-16
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1647101YA0400X, 101YA0400X
LA7153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
72-1407758OtherIRS