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1770948945
FAURICE RUSSEAU
PASADENA, CA
NPI
1770948945
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-12-15
Last Update Date
2015-12-15
Business Address
-- FAURICE RUSSEAU
1680 N FAIR OAKS AVE
PASADENA, CA 91103-1642
Phone number: 626-798-0884
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Mailing Address
-- FAURICE RUSSEAU
1680 N LAKE AVE APT. 2
PASADENA, CA 91104-2328
Phone number: 626-627-2499
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