Provider Demographics
NPI:1487801197
Name:RUSSELL, ELAINE WORTHAM (LPC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:WORTHAM
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 ALFORD AVENUE
Mailing Address - Street 2:PASTORAL CARE AND COUNSELING
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226
Mailing Address - Country:US
Mailing Address - Phone:205-824-8320
Mailing Address - Fax:
Practice Address - Street 1:1313 ALFORD AVENUE
Practice Address - Street 2:PASTORAL CARE AND COUNSELING
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226
Practice Address - Country:US
Practice Address - Phone:205-824-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional