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General NPI Number Information
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NPI Number | 1255359154
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Entity Type | Organization
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Legal Business Name | L.D.D., INC.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5810 42ND AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1634
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Country | US
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Telephone | 763-531-9488
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Fax | 763-531-9591
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Provider Business Mailing Address
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Address Line | 5810 42ND AVE N
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City | ROBBINSDALE
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State | MN
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Zip | 55422-1634
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Country | US
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Telephone | 763-531-9488
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Fax | 763-531-9591
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | MR. SAMUEL L. STERN
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Credential | J.D.
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Telephone | 763-531-9488
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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 | 8070981CDT
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License Number State | MN
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