Provider Demographics
NPI:1235240805
Name:CARLTON, RUSSELL PARRISH SR (DMIN, LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:PARRISH
Last Name:CARLTON
Suffix:SR
Gender:M
Credentials:DMIN, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22636 GLENN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4442
Mailing Address - Country:US
Mailing Address - Phone:703-544-9778
Mailing Address - Fax:
Practice Address - Street 1:22636 GLENN DR
Practice Address - Street 2:SUITE 105
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4494
Practice Address - Country:US
Practice Address - Phone:703-544-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002039101YP2500X
TX3476106H00000X
NC521106H00000X
VA0717000089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional