Individual
DR. TERESA MARIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LCPC, LCADC
Contact information
Practice address
10299 REINDEER PL, NEW MARKET, MD 21774-6818
(240) 575-1206
Mailing address
10299 REINDEER PL, NEW MARKET, MD 21774-6818
(240) 575-1206
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CP000009
NV
101YP2500X
Professional Counselor
CP000009
NV
101YP2500X
Professional Counselor
Primary
LC5788
MD
101YP2500X
Professional Counselor
MHC863
HI
101YP2500X
Professional Counselor
TPMC80
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
074657600
—
MD
05
—
100507626
—
NV
Enumeration date
05/17/2006
Last updated
04/30/2025
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