Individual
MR. RUSSELL SHANE VINER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
501 SOUTHWEST FRONTAGE ROAD, GRENADA, MS 38901-0000
(662) 226-3762
Mailing address
PO BOX 1251, GRENADA, MS 38902-1251
(662) 226-3762
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0563
MS
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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