Provider Demographics
NPI:1780577445
Name:RUSSELL, QUNESHA
Entity type:Individual
Prefix:
First Name:QUNESHA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SCARAB DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2746
Mailing Address - Country:US
Mailing Address - Phone:863-245-5724
Mailing Address - Fax:863-245-5724
Practice Address - Street 1:1103 SCARAB DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2746
Practice Address - Country:US
Practice Address - Phone:863-245-5724
Practice Address - Fax:863-245-5724
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW248351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical