| Doctor Name: | MR. DEREK RUTTER |
| NPI Number: | 1235506585 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPCA, LCAS-A |
| License Number: | LCAS-21141 |
| Business Practice Address: | 631 Willow Creek Rd Leicester, NC - 287485646 |
| Business Phone Number: | 8283180148 |
| Business Fax Number: | |
| Mailing Address: | 631 Willow Creek Rd, LEICESTER |
| State: | NC |
| Postal Code: | 287485646 |
| Phone Number: | 8283180148 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2015 |
| NPI Last Update Date: | 08/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCAS-21141 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |