Individual
MR. CORY ANTHONY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCI
Contact information
Practice address
438 BARNWELL RD, ALLENDALE, SC 29810
(803) 584-4636
Mailing address
1050 RIBAUT RD, BEAUFORT, SC 29902-5400
(843) 524-8899
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6131
SC
Other
Enumeration date
04/30/2014
Last updated
05/09/2025
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