Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 305862 | MN |
NPI | 1003483694 |
---|---|
Provider Name | Regina Anne Mustafa |
First Address | Rochester, MN 55901-2198 |
Second Address | Rochester, MN 55902-3256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |