Provider Demographics
NPI:1619327145
Name:RUSSELL, DOROTHY (LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 CENTRAL AVE N STE 203
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-2915
Mailing Address - Country:US
Mailing Address - Phone:701-490-3281
Mailing Address - Fax:701-490-3283
Practice Address - Street 1:323 CENTRAL AVE N STE 203
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-2915
Practice Address - Country:US
Practice Address - Phone:701-490-3281
Practice Address - Fax:701-490-3283
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND705-12-1-11101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health