Healthcare Provider Details

I. General information

NPI: 1528471877
Provider Name (Legal Business Name): AMY RUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COURT ST
LYNCHBURG VA
24504-1312
US

IV. Provider business mailing address

620 COURT ST
LYNCHBURG VA
24504-1312
US

V. Phone/Fax

Practice location:
  • Phone: 434-847-8035
  • Fax: 434-455-2720
Mailing address:
  • Phone: 434-847-8035
  • Fax: 434-455-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005080
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: