Individual
LYDIA PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGSW, LADC
Contact information
Practice address
5354 PARKDALE DR FL 3, ST LOUIS PARK, MN 55416-1603
(919) 287-6274
Mailing address
1367 WILLOW ST APT 308, MINNEAPOLIS, MN 55403-2578
(507) 381-5920
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
305955
MN
101YM0800X
Mental Health Counselor
Primary
32713
MN
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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