Provider Demographics
NPI:1558315465
Name:RUSS, DEBORAH D
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:D
Last Name:RUSS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:JANE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SWCMHC, 215 N. MAGNOLIA ST.
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-1946
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:SWCMHC/CRISIS, 764 WEST LIBERTY ST.
Practice Address - Street 2:2 MEDICAL CT.
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29151-1946
Practice Address - Country:US
Practice Address - Phone:803-773-9210
Practice Address - Fax:803-778-6598
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor