Provider Demographics
NPI:1124379938
Name:RUTH, DANIELLE LAUREN (MS, NCC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LAUREN
Last Name:RUTH
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4107
Mailing Address - Country:US
Mailing Address - Phone:678-429-4225
Mailing Address - Fax:
Practice Address - Street 1:538 ADAMS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4107
Practice Address - Country:US
Practice Address - Phone:678-429-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health