Individual
MRS. BETHANY C RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
116 STATE ST, AUGUSTA, ME 04330-5632
(207) 877-1041
Mailing address
17 SELDEN LN, OAKLAND, ME 04963-5081
(207) 877-1041
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LC22511
ME
Other
Enumeration date
07/21/2021
Last updated
07/17/2023
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