Individual
PRENTISS J PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4105 TUDOR CENTRE DRIVE, ANCHORAGE, AK 99508
(907) 565-4000
(907) 565-4011
Mailing address
4105 TUDOR CENTRE DRIVE, ANCHORAGE, AK 99508
(907) 565-4000
(907) 565-4011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
732
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH6578
—
AK
Enumeration date
05/01/2007
Last updated
07/09/2007
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