Provider Demographics
NPI:1740795160
Name:RUSSELL, ELIZABETH R (BA, BS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:BA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9609 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-4621
Mailing Address - Country:US
Mailing Address - Phone:804-275-1116
Mailing Address - Fax:804-275-1850
Practice Address - Street 1:9609 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-4621
Practice Address - Country:US
Practice Address - Phone:804-275-1116
Practice Address - Fax:804-275-1850
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)