Individual
RACHEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
122 4TH AVE STE 200, INDIALANTIC, FL 32903-3112
(321) 327-3793
Mailing address
241 SAND DOLLAR RD, INDIALANTIC, FL 32903-2111
(321) 427-5512
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8845
FL
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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