Healthcare Provider Details

I. General information

NPI: 1881028215
Provider Name (Legal Business Name): HEATHER W PRUNTY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KATELYN CIR STE C
WARNER ROBINS GA
31088-6484
US

IV. Provider business mailing address

719 BRODERICK CIR
WARNER ROBINS GA
31088-2415
US

V. Phone/Fax

Practice location:
  • Phone: 678-664-8742
  • Fax: 844-853-5737
Mailing address:
  • Phone: 478-919-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC007092
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007092
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPC007092
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: