Individual
RUSSELL MEYERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
280 SALTER PATH RD, PINE KNOLL SHORES, NC 28512-6120
(252) 240-0019
Mailing address
280 SALTER PATH RD, PINE KNOLL SHORES, NC 28512-6120
(252) 240-0019
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-20883
NC
Other
Enumeration date
01/22/2017
Last updated
01/22/2017
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