Individual
LAVONNE LENAIR RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCASA
Contact information
Practice address
408 CROYDON LN, WINSTON SALEM, NC 27107-6810
(336) 473-8439
Mailing address
408 CROYDON LN, WINSTON SALEM, NC 27107-6810
(336) 473-8439
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
26842
NC
Other
Enumeration date
12/16/2021
Last updated
12/16/2021
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