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Individual
TRACI PAGE
Active
Individual
TRACI PAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LPCC LADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303916
MN
101YM0800X
Mental Health Counselor
Primary
0311
MN
101YP2500X
Professional Counselor
Primary
940
MN
Other
Enumeration date
08/04/2014
Last updated
08/12/2026
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