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Contact Information

JERELYN S RUSSELL
1077 KINCAID BRIDGE RD.
WINNSBORO, SC29180
 Phone: 803-635-9416
 Fax: 803-815-0403
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community Health Worker

172V00000X
 

Counselor

101Y00000X
Indicates primary specialty

NPI Profile & details for JERELYN S RUSSELL · (Female)

NPI Number 1801041124
Status Active
Credentials
Entity Individual
Enumeration date 12/01/2008
Last updated 12/01/2008 - About 18 years ago
Sole proprietor 1 Yes
Identifiers
  • SC License # 101Y00000X
  • SC License # 172V00000X
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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