Individual
MRS. ELISA SARMENTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LADC
Contact information
Practice address
4462 REINDEER LN, EAGAN, MN 55123-2096
(949) 566-5908
Mailing address
4462 REINDEER LN, EAGAN, MN 55123-2096
(949) 566-5908
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305289
MN
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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