Individual
NIKIA M GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSE, LPCC, LADC
Contact information
Practice address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012-9640
(651) 213-4525
Mailing address
7039 20TH AVE S, CENTERVILLE, MN 55038-9737
(651) 288-0332
(651) 288-0493
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303813
MN
101YM0800X
Mental Health Counselor
Primary
CC00656
MN
101YP2500X
Professional Counselor
CC00656
MN
Other
Enumeration date
03/13/2014
Last updated
10/11/2019
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