Provider Demographics
NPI:1528567278
Name:RAINEY, RUSSELL CRAIG (LPC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CRAIG
Last Name:RAINEY
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 1:805 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4260
Mailing Address - Country:US
Mailing Address - Phone:601-268-8796
Mailing Address - Fax:601-336-7563
Practice Address - Street 1:805 W PINE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4260
Practice Address - Country:US
Practice Address - Phone:601-268-8796
Practice Address - Fax:601-336-7563
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional