Individual
ELEXUS L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 SCHOOL ST APT 100-1, ALBANY, GA 31705-2359
(912) 380-0043
Mailing address
100 SCHOOL ST # 100-1, ALBANY, GA 31705-2359
(912) 380-0043
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB966793
GA
Other
Enumeration date
09/12/2023
Last updated
09/13/2023
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