Provider Demographics
NPI:1033815188
Name:HOLLINGSWORTH-PRUITT, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HOLLINGSWORTH-PRUITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WOODBINE DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-9607
Mailing Address - Country:US
Mailing Address - Phone:910-261-7237
Mailing Address - Fax:
Practice Address - Street 1:2148 HWY 401 BUS
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5857
Practice Address - Country:US
Practice Address - Phone:910-565-2857
Practice Address - Fax:910-248-6258
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP017606101Y00000X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health