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NPI Code Detail

MEDICARE: MS. CHANDA J PALACIOS-HADLOCK LPCC, LADC

MEDICARE: MS. CHANDA J PALACIOS-HADLOCK LPCC, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor303459MN
2101YM0800XMental Health CounselorCC04417MN

General Provider Information

NPI Number : 1366282519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHANDA J PALACIOS-HADLOCK LPCC, LADC
Provider Business Mailing Address
First Line : 2211 CLINTON AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3656
Country : US
Telephone Number : 612-449-1144
Fax Number : 612-871-0929
Provider Business Practice Location Address
First Line : 2211 CLINTON AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3656
Country : US
Telephone Number : 612-449-1144
Fax Number : 612-871-0929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2024
Last Update Date : 05/27/2024

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