Individual
TIFFANY T RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6245 DRY FORK RD, DRY FORK, VA 24549-4139
(434) 710-0831
Mailing address
6245 DRY FORK RD, DRY FORK, VA 24549-4139
(434) 710-0831
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
11862
VA
Other
Enumeration date
10/23/2025
Last updated
10/24/2025
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