Organization
SENIOR RECOVERY PROGRAM
Active
Other names
Senior Chemical Dependency Counseling and Assistance Association
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T. CLAWSON (EXECUTIVE DIRECTOR)
(651) 773-0473
Entity
Organization
Contact information
Practice address
2375 ARIEL AVE., MAPLEWOOD, MN 55109
(651) 773-0473
Mailing address
2375 ARIEL AVE., MAPLEWOOD, MN 55109
(651) 773-0473
(651) 773-9298
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
808754-3-CDT
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
446517200
CONSOLIDATED FUND
MN
01
—
808754
RULE 31 CLINIC DEPT OF HUMAN SERVICES
MN
Enumeration date
10/21/2006
Last updated
10/30/2009
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