Provider Demographics
NPI:1295464824
Name:PADILLA, ADRIAN (BA, LADC)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:BA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131971
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-0022
Mailing Address - Country:US
Mailing Address - Phone:651-404-2000
Mailing Address - Fax:
Practice Address - Street 1:1246 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4125
Practice Address - Country:US
Practice Address - Phone:651-404-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305496101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty