Provider Demographics
NPI:1326365909
Name:FANNING, ARLAND PIERRE (LADC)
Entity Type:Individual
Prefix:
First Name:ARLAND
Middle Name:PIERRE
Last Name:FANNING
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6427 PENN AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1142
Mailing Address - Country:US
Mailing Address - Phone:612-465-8110
Mailing Address - Fax:612-455-2568
Practice Address - Street 1:6427 PENN AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-1142
Practice Address - Country:US
Practice Address - Phone:612-465-8110
Practice Address - Fax:612-455-2568
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302298101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)