Individual
NICHOLAS RUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
214 E ELM AVE STE 112, MONROE, MI 48162-2678
(734) 242-4673
(734) 242-4676
Mailing address
214 E ELM AVE STE 112, MONROE, MI 48162-2678
(734) 242-4673
(734) 242-4676
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401012141
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2604097
—
OH
Enumeration date
04/21/2011
Last updated
08/07/2023
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