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General NPI Number Information
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NPI Number | 1568050201
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Entity Type | Individual
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Provider Name | DASHAMELLE JAHONA BOWIE RUSS ACSW, LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 755 S SPRING ST APT 1632
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City | LOS ANGELES
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State | CA
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Zip | 90014-2988
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Country | US
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Telephone | 646-309-1605
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 126042
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 107077-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 98251
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License Number State | CA
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