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NPI Code Detail

MEDICARE: JAMIE MICHELLE RUSSELL CADC

MEDICARE: JAMIE MICHELLE RUSSELL CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCAC8153ME

General Provider Information

NPI Number : 1811703242
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE MICHELLE RUSSELL CADC
Provider Business Mailing Address
First Line : 402 LINCOLNVILLE AVE
Second Line :
City : BELFAST
State : ME
Zip : 04915-7416
Country : US
Telephone Number : 207-322-2705
Fax Number : --
Provider Business Practice Location Address
First Line : 166 NEW COUNTY RD
Second Line :
City : ROCKLAND
State : ME
Zip : 04841-5320
Country : US
Telephone Number : 207-596-0312
Fax Number : 207-596-0319
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2024
Last Update Date : 12/10/2024

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Directions to “ JAMIE MICHELLE RUSSELL CADC” Practice Location

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