Provider Demographics
NPI:1124599717
Name:BORRELLI, RUTHIE
Entity Type:Individual
Prefix:
First Name:RUTHIE
Middle Name:
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MANHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-4713
Mailing Address - Country:US
Mailing Address - Phone:404-771-8503
Mailing Address - Fax:
Practice Address - Street 1:811 MANHASSET RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-4713
Practice Address - Country:US
Practice Address - Phone:404-771-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14390101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor