Provider Demographics
NPI:1730408303
Name:PRUITT, MOLLI ASHMORE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MOLLI
Middle Name:ASHMORE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:MOLLI
Other - Middle Name:DANENE
Other - Last Name:ASHMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAPC, NCC
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:SUNNY SIDE
Mailing Address - State:GA
Mailing Address - Zip Code:30284-0060
Mailing Address - Country:US
Mailing Address - Phone:678-939-2442
Mailing Address - Fax:770-506-9369
Practice Address - Street 1:37 WOOLSEY RD
Practice Address - Street 2:A GROWTH PLACE
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2922
Practice Address - Country:US
Practice Address - Phone:678-939-2442
Practice Address - Fax:770-506-9369
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional