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1467972851
TERRANCE RUSSELL
TARZANA, CA
NPI
1467972851
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-06-27
Last Update Date
2024-12-10
Business Address
TERRANCE RUSSELL DV Facilitator
18700 OXNARD ST
TARZANA, CA 91356-1413
Phone number: 818-991-1051
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Mailing Address
TERRANCE RUSSELL DV Facilitator
1530 W AVENUE K8 APT 49
LANCASTER, CA 93534-6308
Phone number: 323-413-4925
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