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1336385160
RUSSELL P SHIELDS
SANTA ROSA, CA
NPI
1336385160
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2008-12-29
Last Update Date
2014-08-19
Business Address
-- RUSSELL P SHIELDS
1430 NEOTOMAS AVE
SANTA ROSA, CA 95405-7575
Phone number: 707-565-7460
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Mailing Address
-- RUSSELL P SHIELDS
1430 NEOTOMAS AVE
SANTA ROSA, CA 95405-7575
Phone number: 707-565-7460
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