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Individual
MIGNON PRUITT
Active
Individual
MIGNON PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
149006136
IL
101YM0800X
Mental Health Counselor
149006136
IL
1041C0700X
Clinical Social Worker
Primary
149006136
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326447020
GROUP NPI
IL
Enumeration date
09/01/2016
Last updated
09/11/2016
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