Provider Demographics
NPI:1245332329
Name:FAUCETTE, MARY RUTLEDGE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:RUTLEDGE
Last Name:FAUCETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8354
Mailing Address - Country:US
Mailing Address - Phone:843-899-4949
Mailing Address - Fax:843-886-3350
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3764
Practice Address - Country:US
Practice Address - Phone:843-899-4949
Practice Address - Fax:843-899-7224
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC811103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPSO353Medicaid
SC7848Medicare PIN