Organization
NEW SALEM METAMORPHOSIS ADOLESENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HORTENSE JONES AA (PROGRAM ADMINISTRATOR)
(612) 250-8799
Entity
Organization
Contact information
Practice address
2507 BRYANT AVE N, MINNEAPOLIS, MN 55411-2116
(612) 250-8799
Mailing address
2507 BRYANT AVE N, MINNEAPOLIS, MN 55411-2116
(612) 250-8799
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1061325-1-CDT
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
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Other
Enumeration date
07/14/2012
Last updated
07/14/2012
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