Provider Demographics
NPI:1205301553
Name:VIRNIG, MISTY LYNN (MS, LADC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LYNN
Last Name:VIRNIG
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-0223
Mailing Address - Country:US
Mailing Address - Phone:320-360-9163
Mailing Address - Fax:
Practice Address - Street 1:18562 MINOBIMAADIZI LOOP
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-3001
Practice Address - Country:US
Practice Address - Phone:320-532-4163
Practice Address - Fax:320-532-7495
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty