Provider Demographics
NPI:1194312132
Name:RUSSELL, DYANNA LYNN (BS, CADC)
Entity type:Individual
Prefix:MRS
First Name:DYANNA
Middle Name:LYNN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:MS
Other - First Name:DYANNA
Other - Middle Name:LYNN
Other - Last Name:WROBEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:250 MILLIONAIRE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-8251
Mailing Address - Country:US
Mailing Address - Phone:910-241-3273
Mailing Address - Fax:319-390-4381
Practice Address - Street 1:250 MILLIONAIRE RD
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-8251
Practice Address - Country:US
Practice Address - Phone:910-241-3273
Practice Address - Fax:319-390-4381
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)