Individual
MS. ANGELIQUE NOEL RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
1053 N D ST, SAN BERNARDINO, CA 92410-3521
(909) 886-1691
Mailing address
1053 N D ST, SAN BERNARDINO, CA 92410-3521
(909) 886-1691
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
54731
CA
Other
Enumeration date
07/12/2007
Last updated
10/25/2007
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