Individual
MR. JUSTIN CRAWFORD DIEHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
976 JUNO AVENUE, SAINT PAUL, MN 55102
(651) 336-9256
Mailing address
1043 GRAND AVENUE #133, SAINT PAUL, MN 55105
(651) 336-9256
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302571
MN
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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