Individual
GRANT DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC, LADC
Contact information
Practice address
6040 EARLE BROWN DR STE 100, BROOKLYN CENTER, MN 55430-2561
(651) 313-8080
Mailing address
3189 COUNTRYSIDE AVE UNIT F, WOODBURY, MN 55129-7837
(651) 746-9131
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC00991
MN
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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