Provider Demographics
NPI:1093977134
Name:RAKUSIN, AMY RUTH (LCPC, ADTR, NCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:RAKUSIN
Suffix:
Gender:F
Credentials:LCPC, ADTR, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CROSS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1000
Mailing Address - Country:US
Mailing Address - Phone:410-472-3060
Mailing Address - Fax:410-472-9958
Practice Address - Street 1:10 CROSS CREEK CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1000
Practice Address - Country:US
Practice Address - Phone:410-472-3060
Practice Address - Fax:410-472-9958
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional