Provider Demographics
NPI:1659448447
Name:HUFFMAN PRUITT, VICKIE LYNN (LCPC)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:LYNN
Last Name:HUFFMAN PRUITT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 PIPER GLEN DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711
Mailing Address - Country:US
Mailing Address - Phone:217-483-7104
Mailing Address - Fax:217-483-7109
Practice Address - Street 1:7000 PIPER GLEN DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711
Practice Address - Country:US
Practice Address - Phone:217-483-7104
Practice Address - Fax:217-483-7109
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional