Individual
MRS. STACEY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
4302 DANLOU DR, GWYNN OAK, MD 21207-6406
(410) 500-0422
Mailing address
4302 DANLOU DR, GWYNN OAK, MD 21207-6406
(410) 500-0422
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
24387
MD
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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