Individual
IESHA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1708 AUGUSTA ST STE C-226, GREENVILLE, SC 29605-6513
(855) 832-6727
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
SC
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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