Provider Demographics
NPI:1780021162
Name:RUSSELL, VALERIE (LPC)
Entity Type:Individual
Prefix:
First Name:VALERIE
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 1:990 HIGHWAY 51 UNIT 1054
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8409
Mailing Address - Country:US
Mailing Address - Phone:769-233-1616
Mailing Address - Fax:
Practice Address - Street 1:990 HIGHWAY 51 UNIT 1054
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-8409
Practice Address - Country:US
Practice Address - Phone:769-233-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-26
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional