Provider Demographics
NPI:1548976475
Name:RUTHERFORD, LORA MARIE (MS LPC NCC)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:MARIE
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:MS LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BONAR AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1608
Mailing Address - Country:US
Mailing Address - Phone:724-993-4592
Mailing Address - Fax:
Practice Address - Street 1:350 BONAR AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1608
Practice Address - Country:US
Practice Address - Phone:724-993-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional