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1407234172
DAVID LEE RUSSELL
PROVIDENCE, RI
NPI
1407234172
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-05-13
Last Update Date
2015-05-13
Business Address
-- DAVID LEE RUSSELL LCDP
60 COMSTOCK AVE
PROVIDENCE, RI 02907-1206
Phone number: 401-699-1088
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Mailing Address
-- DAVID LEE RUSSELL LCDP
60 COMSTOCK AVENUE
PROVIDENCE, RI 02907
Phone number:
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