Provider Demographics
NPI:1225126030
Name:CONDOL, PAULA J (LPCC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:CONDOL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:J
Other - Last Name:JOHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1303 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2066
Mailing Address - Country:US
Mailing Address - Phone:701-323-5626
Mailing Address - Fax:701-255-4495
Practice Address - Street 1:1303 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2066
Practice Address - Country:US
Practice Address - Phone:701-323-5626
Practice Address - Fax:701-255-4495
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND402-4-15-98-123101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND20555Medicare PIN