Individual
ANDREA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1436 S SHELBY ST, LOUISVILLE, KY 40217-1195
(502) 636-0771
Mailing address
1436 S SHELBY ST, LOUISVILLE, KY 40217-1107
(502) 636-0771
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
255251
KY
171M00000X
Case Manager/Care Coordinator
—
KY
Other
Enumeration date
08/02/2011
Last updated
02/04/2021
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