Healthcare Provider Details

I. General information

NPI: 1629617287
Provider Name (Legal Business Name): RUSTIE MAYES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUSTIE STEBBINS LLMSW

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PROSPECT AVE.
CARO MI
48723
US

IV. Provider business mailing address

97 N SCOTT RD
BAD AXE MI
48413-8840
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-6191
  • Fax: 989-872-1801
Mailing address:
  • Phone: 989-372-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: