Organization
CLINICAL COMMUNITY SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL ANTHONY MARINO LPC (LPC / CEO)
(585) 975-9216
Entity
Organization
Contact information
Practice address
4312 WATERFORD VALLEY DR, SUITE 1321, DURHAM, NC 27713-8342
(585) 975-9216
Mailing address
4312 WATERFORD VALLEY DR, SUITE 1321, DURHAM, NC 27713-8342
(585) 975-9216
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
9058
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538415682
PERSONAL NPI NUMBER
—
Enumeration date
01/09/2016
Last updated
01/09/2016
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