Provider Demographics
NPI:1467079764
Name:RUTLEDGE, LIGAYA JADLOC (LCAS-A)
Entity Type:Individual
Prefix:MS
First Name:LIGAYA
Middle Name:JADLOC
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:MRS
Other - First Name:JOY
Other - Middle Name:JADLOC
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAS-A
Mailing Address - Street 1:608 JACKSON ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-2600
Mailing Address - Country:US
Mailing Address - Phone:252-541-4175
Mailing Address - Fax:252-541-4245
Practice Address - Street 1:608 JACKSON ST STE 108
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2600
Practice Address - Country:US
Practice Address - Phone:252-541-4175
Practice Address - Fax:252-541-4245
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS26295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)