Individual
RICHARD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5 PIONEER RD, WESTBROOK, ME 04092-4523
(207) 357-6173
Mailing address
68 BONNYBRIAR RD, SOUTH PORTLAND, ME 04106-6309
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
XL6578
ME
Other
Enumeration date
06/06/2022
Last updated
06/06/2022
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