Individual
MRS. DIANA LYNN PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CCADC
Contact information
Practice address
2302 HIGHLAND AVE, IRONDALE, AL 35210-1013
(404) 423-6262
Mailing address
2302 HIGHLAND AVE, IRONDALE, AL 35210-1013
(404) 423-6262
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW003433
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181768916A
—
GA
01
—
34008849A
LCSW LICENSE
IN
01
—
4011C
LCSW LICENSE
AL
Enumeration date
12/13/2006
Last updated
07/23/2020
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