Individual
MRS. TARA MCRAE LORENZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1500 14TH ST W STE 290, WILLISTON, ND 58801-4078
(701) 334-6242
Mailing address
307 LAKE ST, NEW SALEM, ND 58563-4101
(707) 530-5098
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCSW62900
CA
1041C0700X
Clinical Social Worker
Primary
LICSW5476
ND
Other
Enumeration date
05/21/2012
Last updated
07/21/2022
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