Provider Demographics
NPI:1053973339
Name:WELLER, CARRIE (LPCC/LADC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:WELLER
Suffix:
Gender:F
Credentials:LPCC/LADC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:MILLIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:945 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55055-1609
Mailing Address - Country:US
Mailing Address - Phone:651-468-4350
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 435S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1907
Practice Address - Country:US
Practice Address - Phone:651-647-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304302101YA0400X
MNCC01795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)