Individual
ALISA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
15 SPENCER AVE NW, CONCORD, NC 28025-4316
(704) 795-7600
(704) 795-7601
Mailing address
PO BOX 1298, CONCORD, NC 28026-1298
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2008
NC
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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