Provider Demographics
NPI:1447602859
Name:RUFFIN, TELLIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TELLIE
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 BAYNARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-3917
Mailing Address - Country:US
Mailing Address - Phone:302-650-3151
Mailing Address - Fax:855-295-5274
Practice Address - Street 1:2005 BAYNARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3917
Practice Address - Country:US
Practice Address - Phone:302-650-3151
Practice Address - Fax:855-295-5274
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0170161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical