Provider Demographics
NPI:1083895296
Name:RUSSELL, SUSAN PAYNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PAYNE
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 1:73 NEW SALEM RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2007
Mailing Address - Country:US
Mailing Address - Phone:828-505-0961
Mailing Address - Fax:
Practice Address - Street 1:1085 TUNNEL ROAD
Practice Address - Street 2:SUITE#3
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2039
Practice Address - Country:US
Practice Address - Phone:828-450-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106814Medicaid