Provider Demographics
NPI:1770118028
Name:RUSSELL, LAURA (LCSW-C LCADC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW-C LCADC
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:POPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:POPP
Mailing Address - Street 1:134 S SCHROEDER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2613
Mailing Address - Country:US
Mailing Address - Phone:443-600-2265
Mailing Address - Fax:
Practice Address - Street 1:8259 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1237
Practice Address - Country:US
Practice Address - Phone:410-630-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA3275101YA0400X
1041C0700X
DCLC2000033201041C0700X
MD263121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)