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Individual

DOMINIQUE M RUSSELMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
271 COLUMBIA BLVD, SAINT HELENS, OR 97051-2021
(503) 397-0391
(503) 366-1067
Mailing address
58646 MCNULTY WAY, SAINT HELENS, OR 97051-6210
(503) 397-5211
(503) 397-5373

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
09/14/2011
Last updated
09/14/2011
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