Individual
DEVIN IRENE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1409 KEMPSVILLE RD, CHESAPEAKE, VA 23320-8134
(757) 416-5290
Mailing address
1409 KEMPSVILLE RD, CHESAPEAKE, VA 23320-8134
(757) 416-5290
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133002506
VA
106S00000X
Behavior Technician
RBT-19-96593
VA
Other
Enumeration date
01/22/2020
Last updated
07/08/2024
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