Provider Demographics
NPI:1578807236
Name:RUSH, STEPHANIE L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L
Last Name:RUSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:608 JACK WARNER PKWY NE APT C3
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5738
Mailing Address - Country:US
Mailing Address - Phone:404-454-7997
Mailing Address - Fax:
Practice Address - Street 1:2020 AVALON PKWY STE 355
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3017
Practice Address - Country:US
Practice Address - Phone:404-454-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010775101YM0800X
GALPC010775101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty