Provider Demographics
NPI:1427243948
Name:DRAKE COUNSELING SERVICES
Entity type:Organization
Organization Name:DRAKE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAREBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-293-5429
Mailing Address - Street 1:1202 23 ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-293-5429
Mailing Address - Fax:701-293-0736
Practice Address - Street 1:1451 44 AVE S
Practice Address - Street 2:UNIT A
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-746-8414
Practice Address - Fax:701-746-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1073163WA0400X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND3002Medicaid