| Doctor Name: | NIKIA MARIE GUSTAFSON |
| NPI Number: | 1811313950 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSED, LPCC, LADC |
| License Number: | 303813 |
| Business Practice Address: | 15251 Pleasant Valley Rd Center City, MN - 550129640 |
| Business Phone Number: | 6512134525 |
| Business Fax Number: | |
| Mailing Address: | Po Box 11, Co-7, 15251 Pleasant Valley Road CENTER CITY |
| State: | MN |
| Postal Code: | 550120011 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/13/2014 |
| NPI Last Update Date: | 03/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 303813 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |