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General NPI Number Information
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NPI Number | 1548391873
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Entity Type | Individual
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Provider Name | VICTORIA CHARLENE RUSH LPC
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Gender | Female
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 5511 RAMSEY ST SUITE 201-A
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-1497
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Country | US
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Telephone | 910-630-6463
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Fax | 910-630-6461
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Provider Business Mailing Address
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Address Line | 3771 RAMSEY ST SUITE 109-119
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-7675
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Country | US
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Telephone | 910-630-6463
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Fax | 910-630-6461
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6495
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License Number State | NC
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