Individual
MARY RUSSELL-WRIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
104 WORTHINGTON CT, TYRONE, GA 30290-1550
(321) 279-7503
Mailing address
104 WORTHINGTON CT, TYRONE, GA 30290-1550
(321) 279-7503
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC 007138
GA
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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