Healthcare Provider Details

I. General information

NPI: 1477926160
Provider Name (Legal Business Name): KWAYULYN RUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KWANJULYNN NORWOOD

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 TURNER POINTE RD
EASLEY SC
29642-9091
US

IV. Provider business mailing address

29600 LAURA RIDGE DR NW
HARVEST AL
35749-5901
US

V. Phone/Fax

Practice location:
  • Phone: 248-632-6448
  • Fax:
Mailing address:
  • Phone: 248-632-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11633
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number239719
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222478
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC04143
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: