Provider Demographics
NPI:1154743235
Name:PRUITT, SHANEKWA MARIE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHANEKWA
Middle Name:MARIE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 PASEO CULTURA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3458
Mailing Address - Country:US
Mailing Address - Phone:619-841-9485
Mailing Address - Fax:619-830-4272
Practice Address - Street 1:2094 PASEO CULTURA
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3458
Practice Address - Country:US
Practice Address - Phone:619-841-9485
Practice Address - Fax:619-830-4272
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71749106H00000X
CA96416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist