Individual
PAUL JOSEPH MCCORMICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
823 MAPLE ST, BRAINERD, MN 56401-3770
(218) 454-3828
Mailing address
27416 COUNTY ROAD 36, AITKIN, MN 56431-6042
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304839
MN
Other
Enumeration date
06/27/2017
Last updated
06/27/2017
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