| Annie Russell Lpc | |
|
4530 S Berkeley Lake Rd Suite B Berkeley Lake GA 30071-1660 | |
| (678) 336-6218 | |
| Not Available |
| Full Name | Annie Russell Lpc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4530 S Berkeley Lake Rd, Berkeley Lake, Georgia |
| Authorized Official Name and Position | Annie Russell (OWNER) |
| Authorized Official Contact | 6783366218 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Annie Russell Lpc 4530 S Berkeley Lake Rd Suite B Berkeley Lake GA 30071-1660 Ph: (678) 336-6218 | Annie Russell Lpc 4530 S Berkeley Lake Rd Suite B Berkeley Lake GA 30071-1660 Ph: (678) 336-6218 |
| NPI Number | 1316482854 |
|---|---|
| Provider Enumeration Date | 12/19/2016 |
| Last Update Date | 12/19/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316482854 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC009369 (Georgia) | Primary |
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