Individual
ERIC PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPCC, LADC
Contact information
Practice address
2855 ANTHONY LN S STE 140, SAINT ANTHONY, MN 55418-2880
(612) 412-4873
Mailing address
2734 DELLWOOD AVE, ROSEVILLE, MN 55113-1825
(218) 393-6744
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
305906
MN
101YM0800X
Mental Health Counselor
Primary
3809
MN
Other
Enumeration date
03/25/2021
Last updated
08/13/2024
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