Provider Demographics
NPI:1801403233
Name:PETTENGILL, EMILY HOPE (LMHC/LCPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:HOPE
Last Name:PETTENGILL
Suffix:
Gender:F
Credentials:LMHC/LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ANDOVER ST STE 125
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1526
Mailing Address - Country:US
Mailing Address - Phone:978-852-1477
Mailing Address - Fax:
Practice Address - Street 1:300 ANDOVER ST STE 125
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1526
Practice Address - Country:US
Practice Address - Phone:978-344-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10000734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health