Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 301462 | MN |
NPI | 1013018480 |
---|---|
Provider Name | Alan A Abraham |
First Address | Virginia, MN 55792 |
Second Address | Virginia, MN 55792 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |