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NPI Code Detail

MEDICARE: MRS. ADALIA M MCCREA LAC

MEDICARE: MRS. ADALIA M MCCREA LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1448ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1026726OTHERNCBSBS OF ND PIN

General Provider Information

NPI Number : 1053327882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADALIA M MCCREA LAC
Provider Business Mailing Address
First Line : PO BOX 650
Second Line : 200 HWY 2 WEST CO LAKE REGION HUMAN SERVICE CENTER
City : DEVILS LAKE
State : ND
Zip : 58301-0650
Country : US
Telephone Number : 701-665-2200
Fax Number : 701-665-2300
Provider Business Practice Location Address
First Line : 200 HIGHWAY 2 W
Second Line : CO LAKE REGION HUMAN SERVICE CENTER
City : DEVILS LAKE
State : ND
Zip : 58301-3532
Country : US
Telephone Number : 701-665-2200
Fax Number : 701-665-2300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 05/09/2013

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Directions to “ MRS. ADALIA M MCCREA LAC” Practice Location

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