Provider Demographics
NPI:1427574326
Name:RUSSELL, ROSIE GENE (CDCA)
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:GENE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 PRIVATE DRIVE 2835
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8118
Mailing Address - Country:US
Mailing Address - Phone:740-858-8235
Mailing Address - Fax:
Practice Address - Street 1:421 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:OH
Practice Address - Zip Code:45619-1020
Practice Address - Country:US
Practice Address - Phone:740-451-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.163477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator