Individual
MICHAELENE COLESTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC, LPCC
Contact information
Practice address
445 ETNA ST STE 55, SAINT PAUL, MN 55106-5848
(651) 756-8561
Mailing address
4365 OAKMEDE LN, WHITE BEAR TOWNSHIP, MN 55110-7606
(651) 402-4055
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
301720
MN
101YM0800X
Mental Health Counselor
Primary
CC00619
MN
Other
Enumeration date
09/12/2016
Last updated
09/02/2024
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