Healthcare Provider Details

I. General information

NPI: 1154378057
Provider Name (Legal Business Name): DRAKE COUNSELING SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 23 ST S
FARGO ND
58103-2951
US

IV. Provider business mailing address

1202 23 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 Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number1073
License Number StateND

VIII. Authorized Official

Name: MRS. TERI VAREBERG
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 701-293-5429