Individual
PHOENIX LYN BLACK WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
1401 E 1ST ST, DULUTH, MN 55805-2407
(218) 728-4491
(218) 730-2367
Mailing address
1401 E 1ST ST, DULUTH, MN 55805-2407
(218) 728-4491
(218) 730-2367
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300519
MN
Other
Enumeration date
08/11/2017
Last updated
08/11/2017
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