Individual
MRS. CHRISTINA MICHELLE RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
124 SUMMER ST, LUCEDALE, MS 39452-5918
(251) 209-8879
Mailing address
10315 BLACKWELL NURSERY RD S, SEMMES, AL 36575-5109
(251) 209-8799
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
3054G
AL
1041C0700X
Clinical Social Worker
Primary
C8553
MS
Other
Enumeration date
09/11/2012
Last updated
05/31/2022
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