Individual
CANDICE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC, LAMFT
Contact information
Practice address
2118 BLAISDELL AVE, MINNEAPOLIS, MN 55404-2415
(612) 235-4692
Mailing address
2118 BLAISDELL AVE, MINNEAPOLIS, MN 55404-2415
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304060
MN
101YM0800X
Mental Health Counselor
3800
MN
Other
Enumeration date
02/13/2019
Last updated
11/16/2020
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