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General NPI Number Information
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NPI Number | 1730408303
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Entity Type | Individual
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Provider Name | MOLLI ASHMORE PRUITT LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 37 WOOLSEY RD A GROWTH PLACE
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City | HAMPTON
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State | GA
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Zip | 30228-2922
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Country | US
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Telephone | 678-939-2442
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Fax | 770-506-9369
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Provider Business Mailing Address
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Address Line | PO BOX 60
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City | SUNNY SIDE
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State | GA
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Zip | 30284-0060
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Country | US
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Telephone | 678-939-2442
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Fax | 770-506-9369
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007126
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License Number State | GA
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