Provider Demographics
NPI:1184940942
Name:RUSSELL, ANNEMARIE (LCSW,ACSW,MPH)
Entity type:Individual
Prefix:MS
First Name:ANNEMARIE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW,ACSW,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 DUKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2926
Mailing Address - Country:US
Mailing Address - Phone:571-730-7065
Mailing Address - Fax:703-642-5483
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:571-730-7065
Practice Address - Fax:703-642-5483
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040071111041C0700X
NY074664-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical