person
Dominique Russell, MA,LPC
Professional Counselor in Gary, Indiana
NPI 1043980139

Dominique Russell is a Professional Counselor based in Gary, IN and is specialized in Professional. Dominique Russell practices in Gary, IN and has the professional credentials of MA,LPC. The NPI Number for Dominique Russell is 1043980139 and holds a License No. 178.017417 (Indiana).

The current practice location address for Dominique Russell is 4520 W Ridge Rd Lot 214, Gary, IN and can be reached out via phone at 312-632-0460.

Location: 4520 W Ridge Rd Lot 214, Gary, IN, 46408-1333
person
Provider Profile Details
NPI Number
1043980139
Provider Name
Dominique Russell
Credential
MA,LPC
Provider Entity Type
Individual
Gender
Female
Address
4520 W Ridge Rd Lot 214, Gary, IN, 46408-1333
Phone Number
312-632-0460
Fax Number
Provider Enumeration Date
09/20/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4520 W Ridge Rd Lot 214
City
State
Zip
46408-1333
Phone Number
312-632-0460
Fax Number
person
Provider Business Mailing Address Details
Address
4520 W Ridge Rd Lot 214
City
State
Zip
46408-1333
Phone Number
312-632-0460
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
178.017417 (Illinois)
Definition
Definition to come...
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