Individual
ANTWINETTE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 UNIVERSITY RD, PEMBROKE, NC 28372-8699
(919) 939-0469
Mailing address
1 UNIVERSITY RD, PEMBROKE, NC 28372-8699
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
P019814
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/13/2022
Last updated
02/23/2026
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