Provider Demographics
NPI:1053672899
Name:RUSSELL, CASSANDRA MCCRAE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MCCRAE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ARNET ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5706
Mailing Address - Country:US
Mailing Address - Phone:734-961-1990
Mailing Address - Fax:734-961-1996
Practice Address - Street 1:103 ARNET ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5706
Practice Address - Country:US
Practice Address - Phone:734-961-1990
Practice Address - Fax:734-961-1996
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002401101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional