Individual
RANDY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
2314 PLYMOUTH AVE N, MINNEAPOLIS, MN 55411-3636
(763) 478-1418
Mailing address
11990 JONQUIL ST NW, COON RAPIDS, MN 55433-1797
(763) 478-1418
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302210
MN
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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