Provider Demographics
NPI:1881028215
Name:PRUNTY, HEATHER W (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:W
Last Name:PRUNTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 BRODERICK CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2415
Mailing Address - Country:US
Mailing Address - Phone:478-919-8904
Mailing Address - Fax:
Practice Address - Street 1:101 KATELYN CIR STE C
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6484
Practice Address - Country:US
Practice Address - Phone:678-664-8742
Practice Address - Fax:844-853-5737
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007092101Y00000X, 101YM0800X, 106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003152827AMedicaid