Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1003478355 |
---|---|
Provider Name | Dr. Chloe Russell |
First Address | Long Beach, CA 90813-3124 |
Second Address | Long Beach, CA 90813-3124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2019 |
Last Update Date | 08/09/2020 |