Provider Demographics
NPI:1912720491
Name:RUTLEDGE, LAUREN AMANDA (LPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:AMANDA
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6762
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24068-6762
Mailing Address - Country:US
Mailing Address - Phone:540-744-6162
Mailing Address - Fax:
Practice Address - Street 1:2791 CHATHAM FARM RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5869
Practice Address - Country:US
Practice Address - Phone:540-998-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health