Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1154619310 |
---|---|
Provider Name | Dr. Alana Renee Russaw |
First Address | Antioch, CA 94509-7319 |
Second Address | Antioch, CA 94509-7319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 28/06/2021 |