Individual
GREGORY JOHN ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1380 ENERGY LN STE 203, SAINT PAUL, MN 55108-5253
(651) 210-5287
(651) 212-4884
Mailing address
6969 VALLEY CREEK ROAD, 220, WOODBURY, MN 55125
(651) 210-5287
(651) 212-4884
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300291
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13465318094
—
MN
Enumeration date
11/21/2019
Last updated
11/21/2019
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