Healthcare Provider Details

I. General information

NPI: 1346567328
Provider Name (Legal Business Name): DRAKE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 8TH AVE N
MOORHEAD MN
56560-2098
US

IV. Provider business mailing address

1202 23RD ST S
FARGO ND
58103-2951
US

V. Phone/Fax

Practice location:
  • Phone: 701-293-5429
  • Fax: 701-293-0736
Mailing address:
  • Phone: 701-293-5429
  • Fax: 701-293-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1044691-1-CDT
License Number StateMN

VIII. Authorized Official

Name: CHARLES P. DRAKE
Title or Position: PRESIDENT
Credential: PH.D
Phone: 701-293-5429