Individual
MR. MARK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
131 WILLOWBROOK DR, SALTILLO, MS 38866-6896
(662) 401-6457
(662) 346-5438
Mailing address
131 WILLOWBROOK DR, SALTILLO, MS 38866-6896
(662) 401-6457
(662) 346-5438
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C9259
MS
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
12/12/2016
Last updated
07/26/2026
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