Individual
BRIAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4823 N ROYAL ATLANTA DR, C, TUCKER, GA 30084-3806
(770) 939-2121
Mailing address
4823 N ROYAL ATLANTA DR, C, TUCKER, GA 30084-3806
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
55815
TX
1041C0700X
Clinical Social Worker
Primary
CSW004391
GA
Other
Enumeration date
05/03/2007
Last updated
02/20/2015
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