Provider Demographics
NPI:1982215703
Name:RUFFER, RUDOLPH (LMSW)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:
Last Name:RUFFER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 LEGACY PARK DR APT 7
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1348
Mailing Address - Country:US
Mailing Address - Phone:517-505-1140
Mailing Address - Fax:
Practice Address - Street 1:183 LEGACY PARK DR APT 7
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1348
Practice Address - Country:US
Practice Address - Phone:517-505-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108235104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker