Individual
COURTNEY NICOLE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., BCBA
Contact information
Practice address
510 PHILADELPHIA PIKE, WILMINGTON, DE 19809-2100
(302) 762-2636
Mailing address
510 PHILADELPHIA PIKE, WILMINGTON, DE 19809-2100
(302) 762-2636
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-55823
DE
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649673427
NPI
—
Enumeration date
12/09/2021
Last updated
12/09/2021
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