Individual
CAROL K RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1107 48TH AVE N, SUITE 111-E, MYRTLE BEACH, SC 29577-5443
(843) 254-9447
(843) 449-8753
Mailing address
1107 48TH AVE. NO., PARKWAY OFFICE PLAZA SUITE 111-E, MYRTLE BEACH, SC 29577-5926
(843) 254-9447
(843) 449-8753
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
1120
NC
106H00000X
Marriage & Family Therapist
Primary
4054
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6105147
—
NC
Enumeration date
10/22/2007
Last updated
02/01/2008
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