Provider Demographics
NPI:1194087221
Name:RUTHERFORD, TINA JORDAN (LICSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:JORDAN
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 ROCKVILLE PIKE
Mailing Address - Street 2:STE 250 PMB211
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1451
Mailing Address - Country:US
Mailing Address - Phone:240-472-7733
Mailing Address - Fax:
Practice Address - Street 1:1451 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1486
Practice Address - Country:US
Practice Address - Phone:240-472-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical