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General NPI Number Information
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NPI Number | 1023952314
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Entity Type | Organization
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Legal Business Name | PROVIDENCE 99:1
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 1330 LAGOON AVE FL 4
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2885
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Country | US
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Telephone | 651-815-9714
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Fax |
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Provider Business Mailing Address
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Address Line | 649 OLD HIGHWAY 8 NW APT 339
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-2873
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Country | US
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Telephone | 651-815-9714
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRYSTA CADALBERT CADALBERT
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Credential | LADC
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Telephone | 651-815-9714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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