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Organization
DIANE G RUSSELL THERAPY SERVICES LLC
Active
Organization
DIANE G RUSSELL THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE G RUSSELL LMSW (SOCIAL WORKER)
(248) 996-5383
Entity
Organization
Contact information
Practice address
640 GRISWOLD ST, SUITE 300, NORTHVILLE, MI 48167-1690
(248) 996-5383
(586) 773-6093
Mailing address
640 GRISWOLD ST, SUITE 300, NORTHVILLE, MI 48167-1690
(248) 996-5383
(586) 773-6093
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801066657
MI
Other
Enumeration date
12/07/2012
Last updated
12/07/2012
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