Individual
KRISTINA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LLMFT
Contact information
Practice address
3351 CLAYSTONE ST SE STE G-32, GRAND RAPIDS, MI 49546-5794
(616) 288-2558
Mailing address
918 FAIRFIELD AVE NW, GRAND RAPIDS, MI 49504-3746
(616) 260-3634
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401016900
MI
101YP2500X
Professional Counselor
Primary
6401019274
MI
106H00000X
Marriage & Family Therapist
4101006827
MI
Other
Enumeration date
11/06/2018
Last updated
04/27/2021
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