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1174040430
RUSSELL THOMAS
LOS ANGELES, CA
NPI
1174040430
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA 169206)
Enumeration Date
2017-08-28
Last Update Date
2017-08-28
Business Address
RUSSELL THOMAS
600 W MANCHESTER AVE
LOS ANGELES, CA 90044-5770
Phone number: 424-703-0344
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Mailing Address
RUSSELL THOMAS
23200 WESTERN AVE
HARBOR CITY, CA 90710-1061
Phone number: 424-703-0344
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