Provider Demographics
NPI:1447268875
Name:RUSSELL, ADRIANA S (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:S
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 CAMINO DIABLO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3997
Mailing Address - Country:US
Mailing Address - Phone:925-945-1485
Mailing Address - Fax:925-969-0544
Practice Address - Street 1:2910 CAMINO DIABLO
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-3997
Practice Address - Country:US
Practice Address - Phone:925-945-1485
Practice Address - Fax:925-969-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist