Provider Demographics
NPI:1902189871
Name:WINTER, GRETA (LADC)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2819
Mailing Address - Country:US
Mailing Address - Phone:218-847-0696
Mailing Address - Fax:218-847-4198
Practice Address - Street 1:1000 8TH ST SE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2819
Practice Address - Country:US
Practice Address - Phone:218-847-0696
Practice Address - Fax:218-847-4198
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302451101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)