Healthcare Provider Details

I. General information

NPI: 1801872445
Provider Name (Legal Business Name): JAMES WILLIAM PRUETT PH.D; D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900-B PARK RD
CHARLOTTE NC
28209
US

IV. Provider business mailing address

664 W HEATHERSTONE LN
ROEBUCK SC
29376-2787
US

V. Phone/Fax

Practice location:
  • Phone: 704-577-5862
  • Fax: 864-574-8142
Mailing address:
  • Phone: 704-577-5862
  • Fax: 864-574-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number41
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: