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General NPI Number Information
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NPI Number | 1942823158
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Entity Type | Individual
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Provider Name | GEORGE JAMES RUTHERFORD
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Gender | Male
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1051 N CANFIELD NILES RD
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City | AUSTINTOWN
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State | OH
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Zip | 44515-1110
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Country | US
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Telephone | 330-935-2663
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 CRANBERRY PT
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City | CRANBERRY TOWNSHIP
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State | PA
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Zip | 16066-7460
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Country | US
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Telephone | 814-715-4535
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCDCII.161640
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License Number State | OH
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