Healthcare Provider Details

I. General information

NPI: 1730888678
Provider Name (Legal Business Name): MICHAEL RUGULEISKI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FOREST DR STE A205
COLUMBIA SC
29204-4146
US

IV. Provider business mailing address

246 COLUMBIA CLUB DR E
BLYTHEWOOD SC
29016-9479
US

V. Phone/Fax

Practice location:
  • Phone: 803-542-9603
  • Fax:
Mailing address:
  • Phone: 803-240-1967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7934
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: