Provider Demographics
NPI:1083042261
Name:WINSTON, WILLIE III (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:
Last Name:WINSTON
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 DUNLAP STREET NORTH
Mailing Address - Street 2:SUITE 825
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-587-6423
Mailing Address - Fax:651-209-3417
Practice Address - Street 1:393 DUNLAP ST N STE 825
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4343
Practice Address - Country:US
Practice Address - Phone:651-587-6423
Practice Address - Fax:651-209-3417
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health