Provider Demographics
NPI:1538504410
Name:SPANN, RUFUS TONY (LCPC)
Entity Type:Individual
Prefix:
First Name:RUFUS
Middle Name:TONY
Last Name:SPANN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SILVER SPRING AVE
Mailing Address - Street 2:308
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4673
Mailing Address - Country:US
Mailing Address - Phone:301-960-8537
Mailing Address - Fax:
Practice Address - Street 1:817 SILVER SPRING AVE
Practice Address - Street 2:308
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4673
Practice Address - Country:US
Practice Address - Phone:301-960-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional