Individual
AISHA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2711 COLONIAL DR, COLUMBIA, SC 29203-6818
(803) 726-9300
Mailing address
213 BEAVER CREEK DR, COLUMBIA, SC 29223-7756
(803) 726-9400
(803) 726-9403
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/06/2013
Last updated
11/06/2013
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