Provider Demographics
NPI:1215149588
Name:DUBOIS RUSSELL, BARBARA J (EDD, LMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:J
Last Name:DUBOIS RUSSELL
Suffix:
Gender:F
Credentials:EDD, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 BRADY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772
Mailing Address - Country:US
Mailing Address - Phone:407-552-7339
Mailing Address - Fax:407-891-2175
Practice Address - Street 1:2925 CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-6504
Practice Address - Country:US
Practice Address - Phone:407-552-7339
Practice Address - Fax:407-891-2175
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8825101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health