Provider Demographics
NPI:1497051445
Name:PRUITT, REBECCA LYNN (LAPC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LEE ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1915
Mailing Address - Country:US
Mailing Address - Phone:678-326-4488
Mailing Address - Fax:678-669-2693
Practice Address - Street 1:2 LEE ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1915
Practice Address - Country:US
Practice Address - Phone:678-326-4488
Practice Address - Fax:678-669-2693
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002687101YP2500X
GA753565101YS0200X
IL178.007099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool