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JENNIFER HAINES-PRUITT LPC
Mental Health >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1962948687
Individual Registrant: JENNIFER HAINES-PRUITT LPC
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
561 THORNTON RD STE R LITHIA SPRINGS, GA 30122-1558 US
Tel: 678-653-6314 Fax: --
Tel: 678-653-6314 Fax: --
Contact information for business:
5463 STONEYBROOK CT SE MABLETON, GA 30126-5625 US
Tel: 937-681-5630 Fax: --
Tel: 937-681-5630 Fax: --
Registration Information:
NPI: 1962948687
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YM0800X | Behavioral Health & Social Service Providers Counselor Mental Health | GA | LPC007776 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 1174512966 | GA | 05 |
