Healthcare Provider Details

I. General information

NPI: 1558315465
Provider Name (Legal Business Name): MS. DEBORAH D. RUSS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. DEBORAH JANE DANIELS

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SWCMHC/CRISIS, 764 WEST LIBERTY ST. 2 MEDICAL CT.
SUMTER SC
29151-1946
US

IV. Provider business mailing address

SWCMHC, 215 N. MAGNOLIA ST.
SUMTER SC
29151-1946
US

V. Phone/Fax

Practice location:
  • Phone: 803-773-9210
  • Fax: 803-778-6598
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: