Provider Demographics
NPI:1730888678
Name:RUGULEISKI, MICHAEL (LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RUGULEISKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 COLUMBIA CLUB DR E
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-9479
Mailing Address - Country:US
Mailing Address - Phone:803-240-1967
Mailing Address - Fax:
Practice Address - Street 1:3800 FOREST DR STE A205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4146
Practice Address - Country:US
Practice Address - Phone:803-542-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health