Individual
MS. KAREN ELIZABETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCC-S, LCDC III
Contact information
Practice address
1925 HAYES AVE, SANDUSKY, OH 44870-4737
(419) 557-5177
(419) 557-5169
Mailing address
1925 HAYES AVE, SANDUSKY, OH 44870-4737
(419) 557-5223
(419) 557-5169
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
01110
OH
101YM0800X
Mental Health Counselor
Primary
E0003775
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011110
LICENSED PROFESSIONAL CHEMICAL DEPENDENCY COUNSELOR III
OH
01
—
E0003775
PROFESSIONAL CLINICAL COUNSELOR
OH
01
—
ICADC 23847
INTERNATIONALLY CERTIFIED ALCOHOL AND DRUG COUNSELOR
—
Enumeration date
10/15/2009
Last updated
10/15/2009
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