Provider Demographics
NPI:1528782034
Name:PRUITT, BERNADETTE J (LGPC)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:J
Last Name:PRUITT
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5206
Mailing Address - Country:US
Mailing Address - Phone:443-909-9640
Mailing Address - Fax:
Practice Address - Street 1:8116 HARFORD RD STE B
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5761
Practice Address - Country:US
Practice Address - Phone:410-779-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health