Healthcare Provider Details

I. General information

NPI: 1427983840
Provider Name (Legal Business Name): RUSSELL MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 PANTHERS RUN DR
DURHAM NC
27713-9185
US

IV. Provider business mailing address

518 PANTHERS RUN DR
DURHAM NC
27713-9185
US

V. Phone/Fax

Practice location:
  • Phone: 215-584-5812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22964
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: