Individual
LISA MARIE VAIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
19247 COUNTY ROAD 44, CLEARWATER, MN 55320-1535
(320) 237-3413
(320) 558-2807
Mailing address
19247 COUNTY ROAD 44, CLEARWATER, MN 55320-1535
(320) 237-3413
(320) 558-2807
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303952
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
303952
ALCOHOL AND DRUG COUNSELOR LICENSE NUMBER
MN
01
—
M983181556620
DRIVERS LICENSE
MN
Enumeration date
08/16/2018
Last updated
08/16/2018
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