Provider Demographics
NPI:1366858557
Name:RUSSELL, SHANNON REBECCA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:REBECCA
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:434 SCOTT BLVD
Mailing Address - Street 2:LIFE POINT SOLUTIONS
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011
Mailing Address - Country:US
Mailing Address - Phone:859-240-0714
Mailing Address - Fax:859-655-4882
Practice Address - Street 1:434 SCOTT BLVD
Practice Address - Street 2:LIFE POINT SOLUTIONS
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011
Practice Address - Country:US
Practice Address - Phone:859-547-5777
Practice Address - Fax:859-655-4882
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2019-10-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical