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General NPI Number Information
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NPI Number | 1598099871
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Entity Type | Organization
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Legal Business Name | CORE RESTORE COUNSELING, LLC
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Dates
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Enumeration Date | 09/20/2009
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Last Update Date | 09/20/2009
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Provider Practice Location Address
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Address Line | 12760 ABERDEEN ST NE STE 205
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City | BLAINE
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State | MN
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Zip | 55449-5847
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Country | US
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Telephone | 763-286-4257
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Fax | 763-432-7424
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Provider Business Mailing Address
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Address Line | 12760 ABERDEEN ST NE STE 205
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City | BLAINE
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State | MN
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Zip | 55449-5847
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Country | US
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Telephone | 763-286-4257
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Fax | 763-432-7424
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Authorized Official
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Title or Position | CO-OWNER
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Name | MRS. STEPHANIE K ROSSING
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Credential | LMFT
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Telephone | 763-286-4257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1185
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License Number State | MN
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