Provider Demographics
NPI:1245097682
Name:CARRUTHERS, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CARRUTHERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CREPE MYRTLE CT APT Q
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-6212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 CREPE MYRTLE CT.
Practice Address - Street 2:APT. Q
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721
Practice Address - Country:US
Practice Address - Phone:229-255-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health