Individual
DAVID LEE RUSSELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDP
Contact information
Practice address
60 COMSTOCK AVE, PROVIDENCE, RI 02907-1206
(401) 699-1088
Mailing address
60 COMSTOCK AVENUE, PROVIDENCE, RI 02907
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
RI
Other
Enumeration date
05/13/2015
Last updated
05/13/2015
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