Individual
VICTOR JONES RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCAS, CSAC
Contact information
Practice address
116 W MAIN ST, WALLACE, NC 28466-2902
(910) 285-5527
(910) 285-5526
Mailing address
230 SPRING DR, JACKSONVILLE, NC 28540-9161
(910) 285-5527
(910) 285-5526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0558
NC
Other
Enumeration date
02/09/2007
Last updated
07/08/2007
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