Provider Demographics
NPI:1750465415
Name:RUSSELL, ELLEN ELIZABETH (LISW-AP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LISW-AP
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:LOUISE
Other - Last Name:SWOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:107 COLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-6750
Mailing Address - Country:US
Mailing Address - Phone:864-314-2204
Mailing Address - Fax:
Practice Address - Street 1:1702 E GREENVILLE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2009
Practice Address - Country:US
Practice Address - Phone:864-224-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health