Provider Demographics
NPI:1033754031
Name:RUSK, KATELYN MARIE (MA,LCAS-A)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:RUSK
Suffix:
Gender:F
Credentials:MA,LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 VIOLA SIPE DR
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8839
Mailing Address - Country:US
Mailing Address - Phone:828-256-3436
Mailing Address - Fax:828-256-3623
Practice Address - Street 1:929 15TH ST NE STE 100
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4162
Practice Address - Country:US
Practice Address - Phone:828-327-6026
Practice Address - Fax:828-327-8796
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25885101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)