Provider Demographics
NPI:1265945893
Name:RUDISILL, SOPHIE (LCSW)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 CLOUDRISE LN
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-7944
Mailing Address - Country:US
Mailing Address - Phone:919-219-4329
Mailing Address - Fax:
Practice Address - Street 1:1229 CLOUDRISE LN
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-7944
Practice Address - Country:US
Practice Address - Phone:919-219-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0084271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical