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General NPI Number Information
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NPI Number | 1750567707
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Entity Type | Individual
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Provider Name | ANITA M. PEMBLETON LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2008
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 3230 E 15TH ST STE C
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City | PANAMA CITY
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State | FL
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Zip | 32405-7423
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Country | US
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Telephone | 850-763-8100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 977
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City | PANAMA CITY
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State | FL
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Zip | 32402-0977
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 8956
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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