Healthcare Provider Details

I. General information

NPI: 1881457745
Provider Name (Legal Business Name): JOY MICHELLE RUSH LGP14788
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 ADMIRAL COCHRANE DR
ANNAPOLIS MD
21401-7307
US

IV. Provider business mailing address

177 ADMIRAL COCHRANE DR
ANNAPOLIS MD
21401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-3058
  • Fax:
Mailing address:
  • Phone: 410-266-3058
  • Fax: 410-266-3257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLGP14788
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: