Organization
LIBERATING MINDS PSYCHOTHERAPY LLC
Active
Other names
ANNIE RUSSELL LPC
Organization subpart
No
Provider details
NPI number
Authorized official
ANNIE RUSSELL LPC (OWNER)
(678) 336-6218
Entity
Organization
Contact information
Practice address
4530 S BERKELEY LAKE RD, SUITE B, BERKELEY LAKE, GA 30071-1660
(678) 336-6218
Mailing address
4530 S BERKELEY LAKE RD, SUITE B, BERKELEY LAKE, GA 30071-1660
(678) 336-6218
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC009369
GA
Other
Enumeration date
12/19/2016
Last updated
12/19/2016
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