MEDICARE: LISA PARKES RUSSELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701013402	VA

General Provider Information

NPI Number	:	1225888225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA PARKES RUSSELL LPC

Provider Business Mailing Address
First Line	:	15290 RUSSELL DR
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-3004
Country	:	US
Telephone Number	:	757-710-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	15290 RUSSELL DR
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-3004
Country	:	US
Telephone Number	:	757-710-0550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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