Active NPI
Laura Lee Rudisill, LCMHC-S
- Professional Counselor
- Shelby, NC
National Provider Identifier
1861495319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- S3261
- Practice address
- 215 S Washington St Ste 104
Shelby, NC 28150-4675 - Phone
- (704) 482-2977
- Fax
- (704) 482-3501
- NPI assigned
- May 28, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 3261 | NC | |
| Professional Counselor | 101YP2500X | S3261 | NC | Primary |
Addresses
Primary practice location
215 S Washington St Ste 104
Shelby, NC 28150-4675
Mailing address
1811 Green Valley Dr
Shelby, NC 28152-7639
Phone (704) 482-2977
Other practice location 1
201 W Marion St
Ste 304
Shelby, NC 28150-5094
Phone (704) 482-2977
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1387Y | Other | NC | BCBS |
| 6102271 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S3261 | NC | MD | Professional Counselor |
| 3261 | NC | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599609600000",
"number": "1861495319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1811 GREEN VALLEY DR",
"city": "SHELBY",
"state": "NC",
"postal_code": "281527639",
"telephone_number": "704-482-2977",
"fax_number": "704-482-3501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 S WASHINGTON ST STE 104",
"city": "SHELBY",
"state": "NC",
"postal_code": "281504675",
"telephone_number": "704-482-2977",
"fax_number": "704-482-3501"
}
],
"practiceLocations": [
{
"address_1": "201 W Marion St",
"address_2": "Ste 304",
"address_purpose": "LOCATION",
"city": "Shelby",
"state": "NC",
"postal_code": "281505094",
"country_code": "US",
"telephone_number": "704-482-2977",
"fax_number": "704-482-3501",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RUDISILL",
"first_name": "LAURA",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "LCMHC-S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-05-28",
"last_updated": "2020-09-09",
"certification_date": "2020-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "3261",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "S3261",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "1387Y",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102271",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelby, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.