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Individual

SADA KATHRYN PUCKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPCC, LADC

Contact information

Practice address
2415 ANNAPOLIS LN N STE 130, PLYMOUTH, MN 55441-3632
(763) 220-0218
Mailing address
2415 ANNAPOLIS LN N STE 130, PLYMOUTH, MN 55441-3632
(763) 220-0218

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304393
MN
101YM0800X
Mental Health Counselor
Primary
02663
MN

Other

Enumeration date
07/02/2021
Last updated
04/08/2022
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