Provider Demographics
NPI:1811922503
Name:OWENS, RUSSELL KENT (LPC)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:KENT
Last Name:OWENS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4661 IVY PATCH DR
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-6897
Mailing Address - Country:US
Mailing Address - Phone:706-315-5474
Mailing Address - Fax:
Practice Address - Street 1:5638 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2408
Practice Address - Country:US
Practice Address - Phone:706-221-9210
Practice Address - Fax:706-221-5427
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004996101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health