Healthcare Provider Details

I. General information

NPI: 1629154695
Provider Name (Legal Business Name): RUTH LOUISE ROSENBAUM M.ED., NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 ASHLEY SQ. CENTER OF WELL-BEING
WINSTON-SALEM NC
27013
US

IV. Provider business mailing address

843 PILOT VIEW ST
WINSTON SALEM NC
27101-2511
US

V. Phone/Fax

Practice location:
  • Phone: 336-794-2343
  • Fax:
Mailing address:
  • Phone: 336-201-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6031
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: