| NPI | 1487994919 |
|---|---|
| Former Name | MICAH J RUSSELL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.013357) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16627-130) | |
| 101YP2500X Counselor, Professional | |
| 101YP2500X Counselor, Professional (Licence: CA LPCC5913) | |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2023-04-18 |