Provider Demographics
NPI:1427667278
Name:RUSSELL, VALERIE (LCSW-A)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 LAKEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0610
Mailing Address - Country:US
Mailing Address - Phone:910-354-4831
Mailing Address - Fax:
Practice Address - Street 1:6209 LAKEHAVEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-0610
Practice Address - Country:US
Practice Address - Phone:910-354-4831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0146491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical