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Individual
DR. SUSAN F RUSSELL
Active
Individual
DR. SUSAN F RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD,THD, L.AC.,LMSW
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
001798 LMSW
GA
103TF0000X
Family Psychologist
1798 LMSW
GA
171100000X
Acupuncturist
Primary
87
GA
Other
Enumeration date
09/26/2011
Last updated
09/26/2011
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