Provider Demographics
NPI:1093219826
Name:RYCROFT, JAIME RUTH (CADCI)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:RUTH
Last Name:RYCROFT
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:SALTER
Other - Last Name:RYCROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADCI
Mailing Address - Street 1:2402 TIFT AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1885
Mailing Address - Country:US
Mailing Address - Phone:229-382-7898
Mailing Address - Fax:229-386-5818
Practice Address - Street 1:2402 TIFT AVE N STE 202
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1885
Practice Address - Country:US
Practice Address - Phone:229-382-7898
Practice Address - Fax:229-386-5818
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA862101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)