MEDICARE: MR. CRAIG A RUSHING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LC1730	MD

General Provider Information

NPI Number	:	1477826402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG A RUSHING

Provider Business Mailing Address
First Line	:	1811 PLYMOUTH CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1661
Country	:	US
Telephone Number	:	410-562-5248
Fax Number	:	410-800-4781

Provider Business Practice Location Address
First Line	:	4710 PENNINGTON AVE
Second Line	:	SUITE 6
City	:	BALTIMORE
State	:	MD
Zip	:	21226-1405
Country	:	US
Telephone Number	:	410-562-5248
Fax Number	:	410-800-4781

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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