Provider Demographics
NPI:1184056608
Name:RUSSAW, ANNIKA MARIE (MS)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:MARIE
Last Name:RUSSAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 OLD HIGHWAY 41
Mailing Address - Street 2:SUITE 750
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3415 OLD HIGHWAY 41
Practice Address - Street 2:SUITE 750
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1028
Practice Address - Country:US
Practice Address - Phone:678-574-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health