Provider Demographics
NPI:1225671415
Name:KNIGHT, SUKIMO DOLORES (LADC)
Entity Type:Individual
Prefix:
First Name:SUKIMO
Middle Name:DOLORES
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:1606 WESTMINSTER ST # 312
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3036
Mailing Address - Country:US
Mailing Address - Phone:651-621-4445
Mailing Address - Fax:
Practice Address - Street 1:1606 WESTMINSTER ST # 312
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3036
Practice Address - Country:US
Practice Address - Phone:651-621-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)