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1962280024
JACLYN RUSSO
CHARLOTTE, NC
NPI
1962280024
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
103TC2200X Psychologist, Clinical Child & Adolescent
(Licence: NC 6402)
Enumeration Date
2023-09-20
Last Update Date
2023-09-20
Business Address
Dr. JACLYN RUSSO PhD
4722 PARK RD STE B
CHARLOTTE, NC 28209-3802
Phone number: 704-665-7424
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Mailing Address
Dr. JACLYN RUSSO PhD
4722 PARK RD STE B
CHARLOTTE, NC 28209-3802
Phone number: 704-665-7424
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