Provider Demographics
NPI:1255380598
Name:RUBIN, MICHAL (PHD)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:RUBIN
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 1:1821 PICKENS ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2630
Mailing Address - Country:US
Mailing Address - Phone:803-376-4005
Mailing Address - Fax:803-376-4005
Practice Address - Street 1:1821 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2630
Practice Address - Country:US
Practice Address - Phone:803-376-4005
Practice Address - Fax:803-376-4005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05012811101YA0400X
SC2781101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health