Healthcare Provider Details

I. General information

NPI: 1194409060
Provider Name (Legal Business Name): MARGARET MARY CZERNIA MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 WHITEWATER DR STE 101
MINNETONKA MN
55343-4157
US

IV. Provider business mailing address

5117 WILLISTON RD
MINNETONKA MN
55345-4731
US

V. Phone/Fax

Practice location:
  • Phone: 952-999-6097
  • Fax:
Mailing address:
  • Phone: 815-325-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC03880
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: