Provider Demographics
NPI:1588551758
Name:RUSSELL, ANNA GRACE (NCC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N 17TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2851
Mailing Address - Country:US
Mailing Address - Phone:224-256-8070
Mailing Address - Fax:
Practice Address - Street 1:505 OLD YORK RD.
Practice Address - Street 2:SUITE 110
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-598-2038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health