Individual
LISA CAROLYN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
101 E BROADWAY AVE, BISMARCK, ND 58501-3840
(701) 222-0386
(701) 255-4891
Mailing address
101 E BROADWAY AVE, BISMARCK, ND 58501-3840
(701) 222-0386
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1795
ND
Other
Enumeration date
09/19/2017
Last updated
09/19/2017
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