Individual
MS. ANNETTE B. CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LISAC
Contact information
Practice address
642 DAMERON DR, PRESCOTT, AZ 86301-2411
(928) 445-5211
(928) 776-0963
Mailing address
642 DAMERON DR, PRESCOTT, AZ 86301-2411
(928) 445-5211
(928) 776-0963
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-10423
AZ
101YP2500X
Professional Counselor
LPC-10149
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
590027
AHCCCS #
AZ
Enumeration date
06/02/2006
Last updated
09/11/2025
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