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Organization
FAA ADDICTION SERVICES
Active
Organization
FAA ADDICTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONDELL GANTZER (OFFICE MANAGER)
(701) 720-2964
Entity
Organization
Contact information
Practice address
900 N BROADWAY STE 111, MINOT, ND 58703-2378
(701) 537-4191
Mailing address
900 N BROADWAY STE 111, MINOT, ND 58703-2378
(701) 537-4191
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159488
—
ND
Enumeration date
08/06/2019
Last updated
02/05/2020
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