Basic Information
| Provider Information | |||||||||
| NPI: | 1588094122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVITO | ||||||||
| FirstName: | RUTH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CORTEZ | ||||||||
| OtherFirstName: | RUTH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1101 EXCHANGE PL APT 537 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277131890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546439196 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 943 W ANDREWS AVE | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275362516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524330061 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2013 | ||||||||
| LastUpdateDate: | 03/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | A12691 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.