Individual
SUSAN M. RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
319 UNION ST, BANGOR, ME 04401-4607
(207) 942-2199
Mailing address
34 BEECHWOOD AVE, OLD TOWN, ME 04468-9749
(207) 827-8977
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC 2971
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231900099
—
ME
Enumeration date
02/05/2007
Last updated
06/01/2009
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