Provider Demographics
NPI:1386185247
Name:WIERSON, RALITSA (MA LPC)
Entity type:Individual
Prefix:
First Name:RALITSA
Middle Name:
Last Name:WIERSON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:RALITSA
Other - Middle Name:
Other - Last Name:GOSPODINOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58707-0002
Mailing Address - Country:US
Mailing Address - Phone:701-858-3371
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707-7464
Practice Address - Country:US
Practice Address - Phone:701-858-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16589101YP2500X
MO2014000734101YP2500X
ND1383-8-1-24101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional