Provider Demographics
NPI:1902393010
Name:RUSSELL, CHRISTOPHER (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-4178
Mailing Address - Country:US
Mailing Address - Phone:276-644-7690
Mailing Address - Fax:
Practice Address - Street 1:43 CHAMPIONS AVE
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-1105
Practice Address - Country:US
Practice Address - Phone:276-523-8300
Practice Address - Fax:276-523-6964
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional