Individual
ANGELA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5921 BEMISS RD, VALDOSTA, GA 31605-7520
(352) 284-6057
Mailing address
5921 BEMISS RD, VALDOSTA, GA 31605-7520
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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