Basic Information
| Provider Information | |||||||||
| NPI: | 1760702781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRUETT | ||||||||
| FirstName: | JANA | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 REINHARDT ST SE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303122318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045027660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1050 SHILOH RD NW | ||||||||
| Address2: | SUITE 316 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301447194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782132194 | ||||||||
| FaxNumber: | 6782132215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW004206 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.