Provider Demographics
NPI:1750164513
Name:FRUITS, JOHN B (MS, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:FRUITS
Suffix:
Gender:M
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1463
Mailing Address - Country:US
Mailing Address - Phone:302-559-6212
Mailing Address - Fax:
Practice Address - Street 1:9 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1463
Practice Address - Country:US
Practice Address - Phone:302-559-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC14102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health