Basic Information
| Provider Information | |||||||||
| NPI: | 1316048960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNOP | ||||||||
| FirstName: | RUSSELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6015 FAYETTEVILLE RD | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277136254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195720001 | ||||||||
| FaxNumber: | 9195720004 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 S MADISON BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275735485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365998366 | ||||||||
| FaxNumber: | 3365972404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 02/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1005 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.