Individual
AMY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
401 BOGLE ST STE 102, SOMERSET, KY 42503-2849
(606) 676-0638
Mailing address
401 BOGLE ST STE 102, SOMERSET, KY 42503-2849
(606) 676-0638
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
260155
KY
101YM0800X
Mental Health Counselor
260155
KY
1041C0700X
Clinical Social Worker
Primary
260155
KY
Other
Enumeration date
03/13/2025
Last updated
03/13/2025
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