Provider Demographics
NPI:1750829883
Name:PRUITT, IRENE TERESA PAZ (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:TERESA PAZ
Last Name:PRUITT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:46 S GLEBE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1655
Mailing Address - Country:US
Mailing Address - Phone:703-521-6004
Mailing Address - Fax:703-521-6342
Practice Address - Street 1:46 S GLEBE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1655
Practice Address - Country:US
Practice Address - Phone:703-521-6004
Practice Address - Fax:703-521-6342
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701005734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional