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MS. YVONNE MARIE RUSS CACII
Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1922251933
Individual Registrant:MS. YVONNE MARIE RUSS CACII
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
415 CLARK STREET TALBOTTON, GA 31827 US
Tel: 706-573-1058 Fax: --
Tel: 706-573-1058 Fax: --
Contact information for business:
415 CLARK STREET P.O. BOX 717 TALBOTTON, GA 31827 US
Tel: 706-573-1058 Fax: --
Tel: 706-573-1058 Fax: --
Registration Information:
NPI: 1922251933
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| CERTIFIED ADDICTION COUNSELOR | 1628-R | GA | 01 |
