Organization
LAWRENCE G. RUFFIN
Active
Other names
Selah Academy, Incorporated
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AQUANATTE M RUFFIN MSW, LCSW (PROGRAM DIRECTOR)
(219) 980-7919
Entity
Organization
Contact information
Practice address
1991 W 39TH CT FL 2, GARY, IN 46408-2474
(219) 980-7919
Mailing address
PO BOX 15090, GARY, IN 46409-5090
(219) 980-7919
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041315A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200818150
—
IN
Enumeration date
12/28/2006
Last updated
08/12/2008
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