Provider Demographics
NPI:1447084884
Name:CADALBERT, CRYSTA ROCHELE (LADC)
Entity type:Individual
Prefix:
First Name:CRYSTA
Middle Name:ROCHELE
Last Name:CADALBERT
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 1:9201 75TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1024
Mailing Address - Country:US
Mailing Address - Phone:763-315-7170
Mailing Address - Fax:763-315-7177
Practice Address - Street 1:9201 75TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1024
Practice Address - Country:US
Practice Address - Phone:763-315-7170
Practice Address - Fax:763-315-7177
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307129101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)