Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Cory Anthony Russell, LPCI

Individual provider Mental Health Counselor · NPI 1720498785

Mr. Cory Anthony Russell, LPCI is a Mental Health Counselor in Allendale, South Carolina. Qualified in 2019, 7 years ago. Practices with Lifesource of North Carolina, a 170-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in South Carolina.

Years since qualifying
7
Licensed in
SC
In the registry since
2014

Practice location Address checks out

438 Barnwell Rd
Allendale, SC 29810
Phone: (803) 584-4636
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 939 Springdale Dr, Clinton, SC 29325-7266 — (910) 742-9243

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 6131 (SC)

Record details

NPI number1720498785
Entity typeIndividual (Type 1)
GenderMale
Credentials LPCI
Sole proprietorNo
NPI enumeratedApril 30, 2014
Last updated in NPPESMay 9, 2025
Certification dateMay 9, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Lifesource Of North Carolina — 170 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Allendale