Individual
DR. JACLYN RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4722 PARK RD STE B, CHARLOTTE, NC 28209-3802
(704) 665-7424
Mailing address
4722 PARK RD STE B, CHARLOTTE, NC 28209-3802
(704) 665-7424
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6402
NC
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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