Provider Demographics
NPI:1598448797
Name:RUTLEDGE, LUKAS D (LCSWA)
Entity Type:Individual
Prefix:
First Name:LUKAS
Middle Name:D
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:TIMBERLAKE
Mailing Address - State:NC
Mailing Address - Zip Code:27583-9267
Mailing Address - Country:US
Mailing Address - Phone:919-627-2043
Mailing Address - Fax:
Practice Address - Street 1:1829 E FRANKLIN ST STE 800D
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5868
Practice Address - Country:US
Practice Address - Phone:919-627-2043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0192251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical