Individual
MISS DONNA MARIE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1814 DIXDALE AVE, LOUISVILLE, KY 40210-2126
(502) 408-4969
Mailing address
1814 DIXDALE AVE, LOUISVILLE, KY 40210-2126
(502) 408-4969
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
257814
KY
Other
Enumeration date
07/19/2023
Last updated
07/11/2024
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