Individual
CARLY CRISTINE MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, LPCC
Contact information
Practice address
7401 METRO BLVD STE 250, EDINA, MN 55439-3062
(612) 268-5858
Mailing address
7401 METRO BLVD STE 250, EDINA, MN 55439-3062
(612) 268-5858
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
305956
MN
101YM0800X
Mental Health Counselor
Primary
3936
MN
101YP2500X
Professional Counselor
3936
MN
Other
Enumeration date
02/11/2021
Last updated
10/23/2024
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