| Doctor Name: | MR. MARK ANDRE DUPONT |
| NPI Number: | 1003932518 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA LP LADC |
| License Number: | 301178 |
| Business Practice Address: | 490 Oak Street Excelsior, MN - 55331 |
| Business Phone Number: | 9524744167 |
| Business Fax Number: | 9524745700 |
| Mailing Address: | 490 Oak Street, EXCELSIOR |
| State: | MN |
| Postal Code: | 55331 |
| Phone Number: | 9524744167 |
| Fax Number: | 9524745700 |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 301178 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |