Provider Demographics
NPI:1376096461
Name:PRUITT, RITA L (LCDC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:L
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:77534-8771
Mailing Address - Country:US
Mailing Address - Phone:713-825-7180
Mailing Address - Fax:
Practice Address - Street 1:1820 COUNTY ROAD 36
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-8727
Practice Address - Country:US
Practice Address - Phone:713-825-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12351101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)