Individual
BRIANNA JAYDE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1190 W ROOSEVELT BLVD, MONROE, NC 28110-2818
(704) 296-6200
Mailing address
284 EXECUTIVE PARK DR, CONCORD, NC 28025-1831
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25982
NC
Other
Enumeration date
04/16/2020
Last updated
04/16/2020
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