Individual
MRS. CASSANDRA MCCRAE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
103 ARNET ST, YPSILANTI, MI 48198-5706
(734) 961-1990
(734) 961-1996
Mailing address
103 ARNET ST, YPSILANTI, MI 48198-5706
(734) 961-1990
(734) 961-1996
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401002401
MI
101YM0800X
Mental Health Counselor
Primary
6401002401
MI
101YP2500X
Professional Counselor
6401002401
MI
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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