Provider Demographics
NPI:1336283324
Name:PRESTRIDGE, PAMELA E (LCSW, PIP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:E
Last Name:PRESTRIDGE
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-3041
Mailing Address - Country:US
Mailing Address - Phone:256-547-6311
Mailing Address - Fax:256-549-1579
Practice Address - Street 1:109 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-3601
Practice Address - Country:US
Practice Address - Phone:256-547-6311
Practice Address - Fax:256-549-7579
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0741-1919C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical