Provider Demographics
NPI:1891424701
Name:NORMAN-PRUITT, JASMONIQUE COLLETTE
Entity Type:Individual
Prefix:
First Name:JASMONIQUE
Middle Name:COLLETTE
Last Name:NORMAN-PRUITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19383 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1310
Mailing Address - Country:US
Mailing Address - Phone:313-482-5079
Mailing Address - Fax:
Practice Address - Street 1:23999 W 10 MILE RD # 220
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3158
Practice Address - Country:US
Practice Address - Phone:248-327-6593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker