Provider Demographics
NPI:1467139881
Name:PRUNEDA, PHOEBE IRELAND (LCSW-A)
Entity Type:Individual
Prefix:
First Name:PHOEBE
Middle Name:IRELAND
Last Name:PRUNEDA
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3437
Mailing Address - Country:US
Mailing Address - Phone:704-871-0934
Mailing Address - Fax:704-402-1065
Practice Address - Street 1:619 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3437
Practice Address - Country:US
Practice Address - Phone:704-871-0934
Practice Address - Fax:704-402-1065
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0191271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical