Organization
COMPLEMENTARY SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERI DAWN DIMOND LICSW (EXECUTIVE DIRECTOR)
(952) 608-8403
Entity
Organization
Contact information
Practice address
6701 PENN AVE S, SUITE #301, RICHFIELD, MN 55423-2093
(952) 608-8403
(612) 861-7589
Mailing address
6701 PENN AVENUE S., SUITE #301, RICHFIELD, MN 55423
(952) 608-8403
(612) 861-7589
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
08879
MN
Other
Enumeration date
12/08/2005
Last updated
08/22/2020
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