Individual
KATHERINE A. RUSSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
500 E OGLETHORPE HWY, HINESVILLE, GA 31313-2804
(843) 577-5011
Mailing address
500 E OGLETHORPE HWY, HINESVILLE, GA 31313-2804
(843) 577-5011
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC6038
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4317289999
—
ME
Enumeration date
09/20/2006
Last updated
12/19/2019
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