Church, Annette B.
Church, Annette B. is an individual health care provider with primary practice located at 642 Dameron Dr , Prescott AZ 86301-2411. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Church, Annette B. can be contacted via phone (928) 445-5211.Contact Information
Primary practice address
642 Dameron Dr
Prescott AZ 86301-2411
Phone: (928) 445-5211
Fax: (928) 776-0963
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | LISAC-10423 | Arizona |
| Behavioral Health & Social Service Providers / Professional | 101YP2500X | LPC-10149 | Arizona |
Profile Details
| NPI number | 1952349011 |
|---|---|
| LBN Legal business name | Church, Annette B. |
| Credentials | LPC, LISAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 2nd, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952349011 | NPPES |
| Arizona | Other | 590027 | AHCCCS # |
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