Individual
MS. LAURA J RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
29 MILLARD FARMER IND BLVD, SUITE B1, NEWNAN, GA 30263-5821
(678) 435-9949
Mailing address
PO BOX 73972, NEWNAN, GA 30271-3972
(678) 435-9949
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
008111
GA
101YM0800X
Mental Health Counselor
6401012348
MI
Other
Enumeration date
12/11/2012
Last updated
12/12/2016
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