Doctor Name: | DEDRA JANENE RUSSELL |
NPI Number: | 1467693432 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RAS |
License Number: | 340018AN |
Business Practice Address: | 1001 Grand Ave Sacramento, CA - 958383512 |
Business Phone Number: | 9169291951 |
Business Fax Number: | 9169295116 |
Mailing Address: | Po Box 38369, SACRAMENTO |
State: | CA |
Postal Code: | 958380369 |
Phone Number: | 9169291951 |
Fax Number: | 9169295116 |
NPI Enumeration Date: | 03/20/2009 |
NPI Last Update Date: | 03/26/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 340018AN |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |