Provider Demographics
NPI:1316710379
Name:RUSSELL, SARAH ELIZABETH (MA, LMFT/A, CTP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, LMFT/A, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SWEETBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-9211
Mailing Address - Country:US
Mailing Address - Phone:864-666-2501
Mailing Address - Fax:
Practice Address - Street 1:144 THOMAS GREEN BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2290
Practice Address - Country:US
Practice Address - Phone:864-584-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist