Provider Demographics
NPI:1548391873
Name:RUSH, VICTORIA CHARLENE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:CHARLENE
Last Name:RUSH
Suffix:
Gender:F
Credentials:LPC
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Other - First Name:
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Mailing Address - Street 1:3771 RAMSEY ST
Mailing Address - Street 2:SUITE 109-119
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7675
Mailing Address - Country:US
Mailing Address - Phone:910-630-6463
Mailing Address - Fax:910-630-6461
Practice Address - Street 1:5511 RAMSEY ST
Practice Address - Street 2:SUITE 201-A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1497
Practice Address - Country:US
Practice Address - Phone:910-630-6463
Practice Address - Fax:910-630-6461
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC6495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103521Medicaid