Provider Demographics
NPI:1235506585
Name:RUTTER, DEREK (LPCA, LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:RUTTER
Suffix:
Gender:M
Credentials:LPCA, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-5646
Mailing Address - Country:US
Mailing Address - Phone:828-318-0148
Mailing Address - Fax:
Practice Address - Street 1:631 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-5646
Practice Address - Country:US
Practice Address - Phone:828-318-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21141101YA0400X
NCA11163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)