Provider Demographics
NPI:1710532924
Name:PRUETT, ASHLEY NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-1137
Mailing Address - Country:US
Mailing Address - Phone:276-964-6702
Mailing Address - Fax:276-964-0292
Practice Address - Street 1:113 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-0810
Practice Address - Country:US
Practice Address - Phone:276-964-6702
Practice Address - Fax:276-964-0292
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional