Provider Demographics
NPI:1801149083
Name:PRENTICE, THERESE E (CA, CHHC, AADP)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:E
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:CA, CHHC, AADP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 SMALLWOOD DR W # 296
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4732
Mailing Address - Country:US
Mailing Address - Phone:240-270-2602
Mailing Address - Fax:
Practice Address - Street 1:2E INDUSTRIAL PARK DR
Practice Address - Street 2:UNIT 165
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:240-270-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral