Individual
DIEM THI KIM HONG CAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, LADC
Contact information
Practice address
2785 WHITE BEAR AVE N, SUIT 403, MAPLEWOOD, MN 55109-1307
(651) 454-0114
(651) 454-3492
Mailing address
3450 OLEARY LN, EAGAN, MN 55123-2340
(651) 454-0114
(651) 454-3492
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
304113
MN
1041C0700X
Clinical Social Worker
Primary
21938
MN
Other
Enumeration date
03/07/2016
Last updated
03/07/2016
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