| NPI | 1538601778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CARROLL Business Owner, Primary Clinician 218-214-6096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MN 1892) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 304598) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2022-08-29 |