Organization Name: | COMPLEMENTARY SUPPORT SERVICES |
NPI Number: | 1023093473 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TERI DAWN DIMOND (EXECUTIVE DIRECTOR) |
Mailing Address: | 6701 Penn Ave S Suite #301 Richfield |
State: | MN US |
Postal Code: | 554232093 |
Phone Number: | 9526088403 |
Fax Number: | 6128617589 |
NPI Enumeration Date: | 12/08/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 08879 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |