Provider Demographics
NPI:1730423401
Name:NAROG, MICHAEL A (BA, LADC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:NAROG
Suffix:
Gender:M
Credentials:BA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 18TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-4756
Mailing Address - Country:US
Mailing Address - Phone:763-389-5080
Mailing Address - Fax:763-631-9117
Practice Address - Street 1:101 18TH AVE N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-4756
Practice Address - Country:US
Practice Address - Phone:763-389-5080
Practice Address - Fax:763-631-9117
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)