Provider Demographics
NPI:1447838495
Name:RUTHERFORD, RAMSEY ETHAN (LPC)
Entity type:Individual
Prefix:
First Name:RAMSEY
Middle Name:ETHAN
Last Name:RUTHERFORD
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5059 VAIL DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7363
Mailing Address - Country:US
Mailing Address - Phone:170-315-2233
Mailing Address - Fax:
Practice Address - Street 1:5059 VAIL DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7363
Practice Address - Country:US
Practice Address - Phone:470-315-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health