Provider Demographics
NPI:1356300677
Name:RUTLEDGE, JAMES WALLACE (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WALLACE
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 WILLOW LN
Mailing Address - Street 2:WEST PARK C61-2
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-3551
Mailing Address - Country:US
Mailing Address - Phone:336-667-5151
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:1430 WILLOW LN
Practice Address - Street 2:WEST PARK C61-2
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3551
Practice Address - Country:US
Practice Address - Phone:336-667-5151
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141F9OtherBCBS OF NC
NC6103062Medicaid