Provider Demographics
NPI:1417165390
Name:WALDROP, RUSSELL GARDNER (LPC)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:GARDNER
Last Name:WALDROP
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-5518
Mailing Address - Country:US
Mailing Address - Phone:540-943-9918
Mailing Address - Fax:
Practice Address - Street 1:225 ROBIN RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-5518
Practice Address - Country:US
Practice Address - Phone:540-943-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6637101YP1600X
VA0701002224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional