Provider Demographics
NPI:1275217408
Name:CLAVER-OBINNA, RUSSELL CHIDINMA (LPC, LCPC)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:CHIDINMA
Last Name:CLAVER-OBINNA
Suffix:
Gender:M
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4244
Mailing Address - Country:US
Mailing Address - Phone:240-686-5390
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4244
Practice Address - Country:US
Practice Address - Phone:240-686-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006081101YP2500X
MDLC14290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional