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General NPI Number Information
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NPI Number | 1801514625
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Entity Type | Organization
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Legal Business Name | THE RECOVERY CONNECT LLC
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 831 COMMONWEALTH AVE
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City | DULUTH
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State | MN
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Zip | 55808-1913
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Country | US
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Telephone | 612-759-5742
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 MAYWOOD ST
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City | SAINT PAUL
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State | MN
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Zip | 55117-4133
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Country | US
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Telephone | 612-759-5742
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Fax |
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Authorized Official
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Title or Position | TREATMENT DIRECTOR
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Name | MRS. CARRIE ANN PHILLIPS
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Credential | LADC
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Telephone | 612-759-5742
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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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