Provider Demographics
NPI:1881457745
Name:RUSH, JOY MICHELLE (LGP14788)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:MICHELLE
Last Name:RUSH
Suffix:
Gender:F
Credentials:LGP14788
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 ADMIRAL COCHRANE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7307
Mailing Address - Country:US
Mailing Address - Phone:410-266-3058
Mailing Address - Fax:410-266-3257
Practice Address - Street 1:177 ADMIRAL COCHRANE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7307
Practice Address - Country:US
Practice Address - Phone:410-266-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14788103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty