Individual
GORDON KENNETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6020 GROVEPORT RD, GROVEPORT, OH 43125-1005
(614) 567-6274
Mailing address
6020 GROVEPORT RD, GROVEPORT, OH 43125-1005
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
185707
OH
Other
Enumeration date
09/28/2023
Last updated
09/28/2023
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