Provider Demographics
NPI:1891329520
Name:RUGG, ANDREW TODD (MS, NCC, APC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TODD
Last Name:RUGG
Suffix:
Gender:M
Credentials:MS, NCC, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 NORTHRIDGE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6101
Mailing Address - Country:US
Mailing Address - Phone:770-771-6900
Mailing Address - Fax:
Practice Address - Street 1:365 NORTHRIDGE RD STE 310
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6101
Practice Address - Country:US
Practice Address - Phone:770-771-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional