Provider Demographics
NPI:1659032696
Name:RUKAVINA, SAMANTHA (NCC, LPC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RUKAVINA
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 RUTLEDGE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5835
Mailing Address - Country:US
Mailing Address - Phone:801-557-0915
Mailing Address - Fax:
Practice Address - Street 1:198 RUTLEDGE AVE STE 8
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5835
Practice Address - Country:US
Practice Address - Phone:843-951-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty