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General NPI Number Information
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NPI Number | 1194312132
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Entity Type | Individual
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Provider Name | DYANNA LYNN RUSSELL B.S, CADC
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Gender | Female
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 250 MILLIONAIRE RD
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City | SAINT PAULS
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State | NC
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Zip | 28384-8251
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Country | US
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Telephone | 910-241-3273
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Fax | 319-390-4381
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Provider Business Mailing Address
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Address Line | 250 MILLIONAIRE RD
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City | SAINT PAULS
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State | NC
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Zip | 28384-8251
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Country | US
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Telephone | 910-241-3273
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Fax | 319-390-4381
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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