Individual
MRS. ANTRECIA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2459 NORWOOD PL, TAVARES, FL 32778-5101
(863) 808-8086
Mailing address
2459 NORWOOD PL, TAVARES, FL 32778-5101
(863) 808-8086
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
FL
Other
Enumeration date
05/10/2024
Last updated
05/10/2024
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