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1710193727
KELLY JEANNE MCCORMICK
FARGO, ND
NPI
1710193727
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ND 1449)
Enumeration Date
2007-05-15
Last Update Date
2007-07-08
Business Address
Ms. KELLY JEANNE MCCORMICK LAC
2101 ELM ST N MENTAL HEALTH
FARGO, ND 58102-2417
Phone number: 701-239-3700
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Mailing Address
Ms. KELLY JEANNE MCCORMICK LAC
406 8TH AVE SW
MANDAN, ND 58554-4029
Phone number: 701-663-5454
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