Provider Demographics
NPI:1558757450
Name:MICHLITSCH, ADELAIDE ADAMS (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:ADAMS
Last Name:MICHLITSCH
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:ADELAIDE
Other - Middle Name:ADAMS
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC
Mailing Address - Street 1:2525 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4404
Mailing Address - Country:US
Mailing Address - Phone:612-871-7443
Mailing Address - Fax:612-871-2257
Practice Address - Street 1:2525 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4404
Practice Address - Country:US
Practice Address - Phone:612-871-7443
Practice Address - Fax:612-871-2257
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303545101YA0400X
MN971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)