Provider Demographics
NPI:1639670946
Name:BAYS, RUSSELL ALAN II (LPC)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALAN
Last Name:BAYS
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:RUSTY
Other - Middle Name:
Other - Last Name:BAYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1454 MEXICO WAY NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6476
Mailing Address - Country:US
Mailing Address - Phone:434-515-3529
Mailing Address - Fax:
Practice Address - Street 1:1454 MEXICO WAY NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6476
Practice Address - Country:US
Practice Address - Phone:434-515-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health