MS. Theresa Joanne Russell, CADC-11

NPI #1255465530 in Pollock Pines, California

Provider Information

NPI Number: 1255465530
Entity Type: Individual
Name: MS. Theresa Joanne Russell, CADC-11
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Specialist
Credential: CADC-11
Enumeration Date: Mar 16, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 5494 PONY EXPRESS TRAIL
City: Pollock Pines
State: California
ZIP Code: 95726
Phone: (530) 664-3758

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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