Individual
KIRSTEN CHARMAIN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
57 INDUSTRIAL PARK RD, LUCEDALE, MS 39452-6583
(601) 947-4274
(601) 947-4275
Mailing address
11263 OLD 63 S APT 59, LUCEDALE, MS 39452-6656
(601) 508-9131
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000181214
—
MS
Enumeration date
02/07/2020
Last updated
02/07/2020
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