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Individual

LYDIA ROSE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MPS, LADC

Contact information

Practice address
PO BOX 73, ROCKFORD, MN 55373-0073
(612) 208-9629
Mailing address
4404 NICOLLET AVE APT 1, MINNEAPOLIS, MN 55419-2642
(612) 208-9629

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
306922
MN
101YM0800X
Mental Health Counselor

Other

Enumeration date
05/06/2025
Last updated
05/06/2025
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