Provider Demographics
NPI:1376665992
Name:ANGELA RUSSELL
Entity Type:Organization
Organization Name:ANGELA RUSSELL
Other - Org Name:IN SEARCH OF PEACE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-574-5976
Mailing Address - Street 1:16306 BROOKTRAIL CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3272
Mailing Address - Country:US
Mailing Address - Phone:301-574-5976
Mailing Address - Fax:301-574-5986
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 139-J
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-574-5976
Practice Address - Fax:301-574-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1591103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000940700Medicaid