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MICHAEL CARR LAC

Addiction Substance Use Disorder

Devils Lake, North Dakota

Provider NPI: 1710922059

Provider Information:
 MICHAEL  CARR LAC
Gender: M
Not Sole Proprietor

Practice Location:
7965 COUNTY 1  DEVILS LAKE, ND 58301 US
Tel: 701-253-6326  Fax: --

Business Mailing Address:
7965 COUNTY 1  DEVILS LAKE, ND 58301 US
Tel: 701-253-6326  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
ND1457

Other Provider Identifiers:

IssuerNumberStateType
54521ND05
BCBS PIN019716ND01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







ADDICTION JOBS ND - Page 1



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