Provider Demographics
NPI:1598085177
Name:PENCE, RUTH MARLENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:MARLENE
Last Name:PENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:MARLENE
Other - Last Name:COMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2717 SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6542
Mailing Address - Country:US
Mailing Address - Phone:757-377-5822
Mailing Address - Fax:
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-490-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040073691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical