Provider Demographics
NPI:1992843106
Name:PREWITT, ANNISE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNISE
Middle Name:
Last Name:PREWITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNISE
Other - Middle Name:
Other - Last Name:BYWATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:644 HOLLAND HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3717
Mailing Address - Country:US
Mailing Address - Phone:702-460-6498
Mailing Address - Fax:702-897-9193
Practice Address - Street 1:600 WHITNEY RANCH DR
Practice Address - Street 2:SUITE D-19A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2611
Practice Address - Country:US
Practice Address - Phone:702-531-3200
Practice Address - Fax:702-531-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4262-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical