Lavonne Lenair Russell, LCASA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

26842 Issued in NC

Practice address

408 Croydon LN
Winston Salem, NC 27107-6810

Phone

(336) 473-8439

NPI assigned

Dec 16, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1255090353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 CROYDON LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271076810",
            "telephone_number": "336-473-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 CROYDON LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271076810",
            "telephone_number": "336-473-8439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "LAVONNE",
        "middle_name": "LENAIR",
        "credential": "LCASA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-16",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "26842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "12.235.47.49",
            "affiliation": "N",
            "endpointDescription": "url ip address",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "IP address",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "408 Croydon Ln",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271076810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessika Lynn Russell
• Judith Anita Russell
• Kathryn Russell, CRNA
• Kenneth R Russell, D.D.S.
• Lauren Kennedy Russell, D.D.S.
• Wilson Glover Russell, MD
• Alison Bridges Russo, LCSW
• Michael Russo
• Sofia Marissa Russo, MD
• Ruth Homecare Services

• Addiction (Substance Use Disorder) Counselor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.