Individual
M. KATHLEEN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
322 W MAIN ST STE 101, RIVERFRONT PLACE, TILTON, NH 03276-5048
(603) 860-1319
(603) 671-7361
Mailing address
322 W MAIN ST STE 101, TILTON, NH 03276-5048
(603) 860-1319
(603) 671-7361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0445
NH
Other
Enumeration date
11/15/2013
Last updated
07/21/2015
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