Organization
LACEY CORNELIUSEN, LICSW, LLC
Active
Other names
Serenity Health Solutions
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY D CORNELIUSEN LICSW (THERAPIST)
(701) 838-1558
Entity
Organization
Contact information
Practice address
315 MAIN ST S, STE 301, MINOT, ND 58701-3956
(701) 838-1558
(701) 852-0402
Mailing address
315 MAIN ST S, STE 301, MINOT, ND 58701-3956
(701) 838-1558
(701) 852-0402
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4558
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19337
—
ND
Enumeration date
01/02/2014
Last updated
01/02/2014
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