Individual
LOLA MARIE BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
921 8TH ST SE, DETROIT LAKES, MN 56501-2840
(218) 844-9730
Mailing address
921 8TH STREET SOUTHEAST, DETROIT LAKES, MN 56501-4219
(218) 844-9730
(218) 844-7754
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305800
MN
Other
Enumeration date
08/12/2021
Last updated
10/03/2021
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