Individual
LARONTA UPSON RUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3760 LAVISTA RD STE 102, TUCKER, GA 30084-5622
(770) 375-8124
(770) 559-5543
Mailing address
3760 LAVISTA RD STE 102, TUCKER, GA 30084-5622
(770) 375-8124
(770) 559-5543
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
003025
GA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
003025
GA
103TS0200X
School Psychologist
003025
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
636448495E
—
GA
Enumeration date
12/02/2006
Last updated
08/14/2024
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