Provider Demographics
NPI:1457966590
Name:RUSSELL, SHANDRICKA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANDRICKA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SHANDRICKA
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:14241 COURSEY BLVD STE A-12
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1368
Mailing Address - Country:US
Mailing Address - Phone:225-333-8008
Mailing Address - Fax:225-416-4068
Practice Address - Street 1:8261 SUMMA AVE STE H
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3452
Practice Address - Country:US
Practice Address - Phone:225-333-8008
Practice Address - Fax:225-416-6048
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty