Individual
MRS. JERELYN S RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1077 KINCAID BRIDGE RD., WINNSBORO, SC 29180
(803) 635-9416
(803) 815-0403
Mailing address
117 N VANDERHORST ST, WINNSBORO, SC 29180-1324
(803) 718-3121
(803) 815-0403
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
101Y00000X
SC
172V00000X
Community Health Worker
Primary
172V00000X
SC
Other
Enumeration date
12/01/2008
Last updated
12/01/2008
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