Provider Demographics
NPI:1912769472
Name:RUTLEDGE, ALAINA NICOLE
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:NICOLE
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 VANDERLYN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-8531
Mailing Address - Country:US
Mailing Address - Phone:937-286-2571
Mailing Address - Fax:
Practice Address - Street 1:1460 VANDERLYN CT
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-8531
Practice Address - Country:US
Practice Address - Phone:937-286-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)