Provider Demographics
NPI:1447210588
Name:RUTLEDGE, MARY T (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 UNIVERSITY EAST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4353
Mailing Address - Country:US
Mailing Address - Phone:704-597-3500
Mailing Address - Fax:704-597-3579
Practice Address - Street 1:8601 UNIVERSITY EAST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4353
Practice Address - Country:US
Practice Address - Phone:704-597-3500
Practice Address - Fax:704-597-3579
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical