| Doctor Name: | VICTOR JONES RUSSELL |
| NPI Number: | 1164563417 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCAS, CSAC |
| License Number: | 0558 |
| Business Practice Address: | 116 W Main St Wallace, NC - 284662902 |
| Business Phone Number: | 9102855527 |
| Business Fax Number: | 9102855526 |
| Mailing Address: | 230 Spring Dr, JACKSONVILLE |
| State: | NC |
| Postal Code: | 285409161 |
| Phone Number: | 9102855527 |
| Fax Number: | 9102855526 |
| NPI Enumeration Date: | 02/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0558 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |