Provider Demographics
NPI:1235410630
Name:PRESCOTT, JANELLE CHAMAE (LMFT,MCAP,ICADC)
Entity type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:CHAMAE
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:LMFT,MCAP,ICADC
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:CHAMAE
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:139 TOWNE SQ
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1242
Mailing Address - Country:US
Mailing Address - Phone:954-540-9445
Mailing Address - Fax:
Practice Address - Street 1:1131 CHAPEL CROSSING ROAD
Practice Address - Street 2:
Practice Address - City:GLYNCO
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:912-554-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLICADA 125995101YA0400X
FL2370106H00000X
FLCAP4834101YA0400X
FLMT2370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLICADC 125995OtherINTERNATIONALLY CERTIFIED ALCOHOL AND DRUG COUNSELOR