Provider Demographics
NPI:1609246396
Name:RUSSELL, DEONIA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:DEONIA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 OSPREY NEST LN
Mailing Address - Street 2:APT 274
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6169
Mailing Address - Country:US
Mailing Address - Phone:850-381-6890
Mailing Address - Fax:
Practice Address - Street 1:2127 GRAND BROOK CIR
Practice Address - Street 2:APT 1423A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6922
Practice Address - Country:US
Practice Address - Phone:850-381-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker