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Individual
MS. LAURA RUSSELL
Active
Individual
MS. LAURA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-C LCADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCA3275
MD
1041C0700X
Clinical Social Worker
Primary
26312
MD
1041C0700X
Clinical Social Worker
LC200003320
DC
Other
Enumeration date
03/06/2020
Last updated
05/03/2024
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