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General NPI Number Information
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NPI Number | 1346567328
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Entity Type | Organization
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Legal Business Name | DRAKE COUNSELING SERVICES
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 919 8TH AVE N
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City | MOORHEAD
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State | MN
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Zip | 56560-2098
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Country | US
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Telephone | 701-293-5429
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Fax | 701-293-0736
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Provider Business Mailing Address
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Address Line | 1202 23RD ST S
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City | FARGO
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State | ND
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Zip | 58103-2951
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Country | US
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Telephone | 701-293-5429
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Fax | 701-293-0736
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES P. DRAKE
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Credential | PH.D
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Telephone | 701-293-5429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1044691-1-CDT
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License Number State | MN
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