Provider Demographics
NPI:1164238325
Name:FLOYD RUSSELL, DESLYS SARAH (LISW/LCSW)
Entity type:Individual
Prefix:
First Name:DESLYS
Middle Name:SARAH
Last Name:FLOYD RUSSELL
Suffix:
Gender:F
Credentials:LISW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90539
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29290-1539
Mailing Address - Country:US
Mailing Address - Phone:803-261-5603
Mailing Address - Fax:
Practice Address - Street 1:3208 TROTTER RD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9754
Practice Address - Country:US
Practice Address - Phone:803-261-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical