Organization
AGATE BAY PROFESSIONALS CHEMICAL HEALTH SERVICES
Active
Organization
AGATE BAY PROFESSIONALS CHEMICAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH CLARK MSW, LICSW, LADC (COUNSELOR & THERAPIST)
(218) 830-8085
Entity
Organization
Contact information
Practice address
227 7TH ST, TWO HARBORS, MN 55616-1530
(218) 830-8085
Mailing address
227 7TH ST, TWO HARBORS, MN 55616-1530
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/03/2013
Last updated
01/31/2022
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