Provider Demographics
NPI:1629154695
Name:ROSENBAUM, RUTH LOUISE (MED, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:LOUISE
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 PILOT VIEW ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2511
Mailing Address - Country:US
Mailing Address - Phone:336-201-2300
Mailing Address - Fax:
Practice Address - Street 1:1316 ASHLEY SQ.
Practice Address - Street 2:CENTER OF WELL-BEING
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27013
Practice Address - Country:US
Practice Address - Phone:336-794-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health