Provider Demographics
NPI:1326311697
Name:RUSH COUNSELING SERVICES
Entity Type:Organization
Organization Name:RUSH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-975-6680
Mailing Address - Street 1:8500 ENFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6612
Mailing Address - Country:US
Mailing Address - Phone:704-975-6680
Mailing Address - Fax:
Practice Address - Street 1:360 N CASWELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2442
Practice Address - Country:US
Practice Address - Phone:704-975-6680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health