Active NPI
Yvonne Marie Russ, LPC, CMAC
- Professional Counselor
- Newnan, GA
National Provider Identifier
1922251933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC010434
- Practice address
- 124 The Ridge CT
Newnan, GA 30265-1186 - Phone
- (706) 573-1058
- NPI assigned
- Nov 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC010434 | GA | Primary |
Addresses
Primary practice location
124 The Ridge CT
Newnan, GA 30265-1186
Mailing address
124 The Ridge CT
Newnan, GA 30265-1186
Phone (706) 573-1058
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1628-R | Other | GA | CERTIFIED ADDICTION COUNSELOR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC010434 | GA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691712000000",
"number": "1922251933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 THE RIDGE CT",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302651186",
"telephone_number": "706-573-1058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 THE RIDGE CT",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302651186",
"telephone_number": "706-573-1058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSS",
"first_name": "YVONNE",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LPC, CMAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-04",
"last_updated": "2023-08-11",
"certification_date": "2023-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC010434",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED ADDICTION COUNSELOR",
"identifier": "1628-R",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newnan, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.