Individual
RANDOLPH ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
5645 LINDSAY ST, GOLDEN VALLEY, MN 55422-4627
(763) 331-5167
Mailing address
5645 LINDSAY ST, GOLDEN VALLEY, MN 55422-4627
(763) 331-5167
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305346
MN
Other
Enumeration date
02/10/2020
Last updated
03/05/2021
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