Individual
MRS. CANDACE LATANYA HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LPCC
Contact information
Practice address
109 N SHORE DR, WAVERLY, MN 55390-5517
(763) 658-5810
Mailing address
1831 PENNSYLVANIA AVE S, ST LOUIS PARK, MN 55426-2042
(918) 770-1672
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1212
MN
Other
Enumeration date
01/12/2017
Last updated
01/12/2017
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