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General NPI Number Information
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NPI Number | 1851737910
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Entity Type | Organization
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Legal Business Name | ALCOHOL AND DRUG ASSESSMENT SERVICES LLC
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 7400 EDINBOROUGH WAY #5312
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City | EDINA
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State | MN
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Zip | 55435-5615
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Country | US
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Telephone | 612-223-0799
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Fax | 612-437-4606
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Provider Business Mailing Address
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Address Line | 7400 EDINBOROUGH WAY #5312
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City | EDINA
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State | MN
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Zip | 55435-5615
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Country | US
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Telephone | 612-223-0799
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Fax | 612-437-4606
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Authorized Official
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Title or Position | OWNER
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Name | BRAD HERMAN
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Credential | LADC
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Telephone | 612-223-0797
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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 | LADC 302934
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License Number State | MN
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