Individual
DHARMA RAJ PANTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC, LPC
Contact information
Practice address
1820 WALNUT ST E, SUIT # 7, DEVILS LAKE, ND 58301-3411
(701) 665-2149
(701) 665-2153
Mailing address
231 KEMP AVE SE, APT # 112, DEVILS LAKE, ND 58301-3978
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1638
ND
101YM0800X
Mental Health Counselor
678-1-1-11
ND
Other
Enumeration date
02/01/2011
Last updated
02/01/2011
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