Individual
TANA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
4800 COLLEGE ST SE, LACEY, WA 98503-4389
(253) 651-1054
(360) 493-5088
Mailing address
4800 COLLEGE ST SE, LACEY, WA 98503-4389
(253) 651-1054
(360) 493-5088
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60520052
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CP60520052
—
WA
Enumeration date
04/06/2018
Last updated
04/06/2018
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