Provider Demographics
NPI:1861751513
Name:PRUITT, PATRICIA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LEE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 MINERAL SPRINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9145
Mailing Address - Country:US
Mailing Address - Phone:803-520-8295
Mailing Address - Fax:803-520-8298
Practice Address - Street 1:2437 MINERAL SPRINGS RD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9145
Practice Address - Country:US
Practice Address - Phone:803-520-8295
Practice Address - Fax:803-520-8298
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC476103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist