Provider Demographics
NPI:1366676421
Name:PRENTISS, ADRIANNE LEIGH (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANNE
Middle Name:LEIGH
Last Name:PRENTISS
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N. BRONSON AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1806
Mailing Address - Country:US
Mailing Address - Phone:231-796-1583
Mailing Address - Fax:231-796-4083
Practice Address - Street 1:110 N. BRONSON AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1806
Practice Address - Country:US
Practice Address - Phone:231-796-1583
Practice Address - Fax:231-796-4083
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010845621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2641009Medicare PIN