Provider Demographics
NPI:1053327882
Name:MCCREA, ADALIA M (LAC)
Entity type:Individual
Prefix:MRS
First Name:ADALIA
Middle Name:M
Last Name:MCCREA
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:200 HWY 2 WEST CO LAKE REGION HUMAN SERVICE CENTER
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-0650
Mailing Address - Country:US
Mailing Address - Phone:701-665-2200
Mailing Address - Fax:701-665-2300
Practice Address - Street 1:200 HIGHWAY 2 W
Practice Address - Street 2:CO LAKE REGION HUMAN SERVICE CENTER
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3532
Practice Address - Country:US
Practice Address - Phone:701-665-2200
Practice Address - Fax:701-665-2300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND1448101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC026726OtherBSBS OF ND PIN