Individual
ANGELA RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, CADC
Contact information
Practice address
14 MAIN STREET, MARS HILL, ME 04758
(207) 425-3880
Mailing address
378 DEVELOPMENT DR, LIMESTONE, ME 04750-6128
(303) 520-4618
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC4911
ME
101YP2500X
Professional Counselor
Primary
XL3802
ME
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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