Individual
BRANDON RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 22ND ST, SACRAMENTO, CA 95816-3503
(209) 748-2470
Mailing address
500 22ND ST, SACRAMENTO, CA 95816-3503
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1510890623
CA
Other
Enumeration date
06/29/2023
Last updated
06/29/2023
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