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Organization

MID-RANGE CHEMICAL DEPENDENCY SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMANDA CLARK LADC (CLINICAL SUPERVISOR)
(218) 262-0860
Entity
Organization

Contact information

Practice address
522 E HOWARD ST STE 101, HIBBING, MN 55746-1714
(218) 262-0860
Mailing address
522 E HOWARD ST STE 101, HIBBING, MN 55746-1714
(218) 262-0860

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1061219
MN

Other

Enumeration date
02/02/2012
Last updated
04/18/2017
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