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1508321423
MARY RUSSELL
JACKSON, TN
NPI
1508321423
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: TN LDC0000000502)
Enumeration Date
2019-02-05
Last Update Date
2019-02-05
Business Address
MARY RUSSELL MSW, LADACII
110 MCCOWAT ST
JACKSON, TN 38301-5279
Phone number: 731-427-7238
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Mailing Address
MARY RUSSELL MSW, LADACII
110 MCCOWAT ST
JACKSON, TN 38301-5279
Phone number: 731-427-7238
Copy
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