Diana Lynn Pruitt, LCSW, CCADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW003433 Issued in GA

Practice address

2302 Highland Ave
Irondale, AL 35210-1013

Phone

(404) 423-6262

NPI assigned

Dec 13, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1699836734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 HIGHLAND AVE",
            "city": "IRONDALE",
            "state": "AL",
            "postal_code": "352101013",
            "telephone_number": "404-423-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 HIGHLAND AVE",
            "city": "IRONDALE",
            "state": "AL",
            "postal_code": "352101013",
            "telephone_number": "404-423-6262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "927 N Pennsylvania St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462041020",
            "country_code": "US",
            "telephone_number": "317-686-9779",
            "fax_number": "317-686-5810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "DIANA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "LCSW, CCADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181768916A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE",
            "identifier": "4011C",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSW LICENSE",
            "identifier": "34008849A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Irondale, AL
• Providers in Irondale, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.