Provider Demographics
NPI:1558252601
Name:RUSH, MARTINA (LPC-A)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:RUSH
Suffix:
Gender:X
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 HUNTERS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-7600
Mailing Address - Country:US
Mailing Address - Phone:843-481-6121
Mailing Address - Fax:
Practice Address - Street 1:2524 E HIGHWAY 76 UNIT H
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-5301
Practice Address - Country:US
Practice Address - Phone:843-481-6121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health