Individual
DEREK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 EISENHOWER AVE STE 604, ALEXANDRIA, VA 22314-4688
(703) 684-0334
Mailing address
8289 DOUBLE POPLARS LN, WARRENTON, VA 20187-8313
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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