Individual
JESSICA MARIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADAC II
Contact information
Practice address
1972 KNOX DR, CLAYTON, IN 46118-9485
(317) 654-8315
Mailing address
1972 KNOX DR, CLAYTON, IN 46118-9485
(317) 654-8315
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
C2-51276
IN
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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