Provider Demographics
NPI:1154401461
Name:PIERZINA, THEODORE J (MN-LADC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:J
Last Name:PIERZINA
Suffix:
Gender:M
Credentials:MN-LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S WALNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1319
Mailing Address - Country:US
Mailing Address - Phone:507-895-6666
Mailing Address - Fax:507-895-6667
Practice Address - Street 1:33 S WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1319
Practice Address - Country:US
Practice Address - Phone:507-895-6666
Practice Address - Fax:507-895-6667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1016047-1-CDT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)