Individual
CARL A RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 H ST, NEEDLES, CA 92363-2928
(760) 326-4590
(760) 326-3154
Mailing address
300 H ST, NEEDLES, CA 92363-2928
(760) 326-4590
(760) 326-3154
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
11/05/2013
Last updated
11/05/2013
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