Individual
LASHANTI MELBA PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
995 ROSWELL ST NE STE 100, MARIETTA, GA 30060-2186
(404) 844-3139
Mailing address
624 WALTON WAY SE, SMYRNA, GA 30082-3857
(404) 844-3139
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
832384688
—
GA
Enumeration date
08/29/2019
Last updated
08/29/2019
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