Provider Demographics
NPI:1063848471
Name:RUSSELL, CAROLINE L (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 SIX FORKS RD STE 505
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6527
Mailing Address - Country:US
Mailing Address - Phone:919-589-2955
Mailing Address - Fax:888-975-6870
Practice Address - Street 1:6512 SIX FORKS RD STE 505
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6527
Practice Address - Country:US
Practice Address - Phone:919-589-2955
Practice Address - Fax:888-975-6870
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC007056A1041C0700X
NCC0087581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical