Individual
MARY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LADACII
Contact information
Practice address
110 MCCOWAT ST, JACKSON, TN 38301-5279
(731) 427-7238
Mailing address
110 MCCOWAT ST, JACKSON, TN 38301-5279
(731) 427-7238
(731) 423-3811
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LDC0000000502
TN
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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