Russell, Teresa Marie

Russell, Teresa Marie is an sole proprietor health care provider with primary practice located at 10292 Chestnut Park Ln , Columbia MD 21044-4951. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Russell, Teresa Marie can be contacted via phone (240) 575-1206.

Contact Information

Primary practice address
10292 Chestnut Park Ln Columbia MD 21044-4951
Phone: (240) 575-1206
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X CP000009 Nevada
Behavioral Health & Social Service Providers / Professional 101YP2500X CP000009 Nevada
Behavioral Health & Social Service Providers / Professional 101YP2500X LC5788 Maryland

Profile Details

NPI number 1134171945
LBN Legal business name Russell, Teresa Marie
Credentials LCPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 17th, 2006
Last updated Jan 7th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134171945 NPPES
Maryland MEDICAID 074657600
Maryland MEDICAID 100507626

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