Individual
DEBRA DONAHUE-SHARSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
37002 W STOCKING DR, MENAHGA, MN 56464-2759
(218) 640-6133
(218) 640-5008
Mailing address
PO BOX F, MENAHGA, MN 56464-0456
(218) 640-6133
(218) 600-5008
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302415
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302415
STATE OF MINNESOTA LADC
MN
Enumeration date
10/26/2016
Last updated
04/27/2020
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