Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ICDC991726 | OH |
Y | 101YP2500X | Professional Counselor | E.0800023LPCC | OH |
N | 104100000X | Social Worker | S.0013326 | OH |
NPI | 1003275652 |
---|---|
Provider Name | Robin Rutan |
First Address | Grove City, OH 43123-9122 |
Second Address | Grove City, OH 43123-9122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 10/02/2016 |