Provider Demographics
NPI:1932665098
Name:PRINCE, ROXANNE (MA, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 WAYZATA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1500
Mailing Address - Country:US
Mailing Address - Phone:952-544-6806
Mailing Address - Fax:
Practice Address - Street 1:10201 WAYZATA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1500
Practice Address - Country:US
Practice Address - Phone:952-544-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303983101YA0400X
MN1457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)