Healthcare Provider Details

I. General information

NPI: 1194861666
Provider Name (Legal Business Name): ROBERT DAVID RUSSELL JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CENTRAL PARK LN
SENECA SC
29678-1156
US

IV. Provider business mailing address

10 FINANCIAL BLVD
ANDERSON SC
29621-1770
US

V. Phone/Fax

Practice location:
  • Phone: 864-844-9432
  • Fax: 864-844-9430
Mailing address:
  • Phone: 864-844-9432
  • Fax: 864-844-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: