Provider Demographics
NPI:1881717437
Name:RUSSELL, DARSI L (LCMHC)
Entity type:Individual
Prefix:MS
First Name:DARSI
Middle Name:L
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4875
Mailing Address - Country:US
Mailing Address - Phone:603-673-2508
Mailing Address - Fax:603-673-2717
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4875
Practice Address - Country:US
Practice Address - Phone:603-673-2508
Practice Address - Fax:603-673-2717
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30425000Medicaid