Individual
ELICIA MARIE OMALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
1911 PLEASANT AVENUE SOUTH, MINNEAPOLIS, MN 55403
(612) 596-0099
(763) 475-4297
Mailing address
1911 PLEASANT AVENUE SOUTH, MINNEAPOLIS, MN 55403
(612) 596-0099
(763) 475-4297
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302540
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302540
LICENSED ALCOHOL AND DRUG COUNSELOR
MN
Enumeration date
10/27/2011
Last updated
10/27/2011
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