Individual
DWAYNE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 COMMON ST STE 500, NEW ORLEANS, LA 70112-2467
(504) 302-1323
Mailing address
1010 COMMON ST STE 500, NEW ORLEANS, LA 70112-2467
(504) 302-1323
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10847
LA
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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