Individual
JENNIFER HAINES-PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
561 THORNTON RD STE R, LITHIA SPRINGS, GA 30122-1558
(678) 653-6314
Mailing address
5463 STONEYBROOK CT SE, MABLETON, GA 30126-5625
(937) 681-5630
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC007776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174512966
—
GA
Enumeration date
01/19/2017
Last updated
09/14/2018
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