Provider Demographics
NPI:1124883061
Name:MAKANT, RUSSELL A (LCMHCA)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:A
Last Name:MAKANT
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 4TH STREET BLVD NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1071
Mailing Address - Country:US
Mailing Address - Phone:828-502-9844
Mailing Address - Fax:
Practice Address - Street 1:255 18TH ST SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1364
Practice Address - Country:US
Practice Address - Phone:828-327-6633
Practice Address - Fax:828-327-3385
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health