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Individual

CARRIE LOIS MAIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MPS, LADC, LPCC

Contact information

Practice address
1811 WEIR DR STE 270, WOODBURY, MN 55125-6741
(651) 714-9648
Mailing address
1131 GOODVIEW AVE N, SAINT PAUL, MN 55128-6129
(651) 329-5041

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304951
MN
101YP2500X
Professional Counselor
Primary
2512
MN

Other

Enumeration date
07/27/2020
Last updated
10/26/2023
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