Active NPI
Lola Marie Booth, LADC
- Addiction (Substance Use Disorder) Counselor
- Detroit Lakes, MN
National Provider Identifier
1093480949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 305800
- Practice address
- 921 8TH St SE
Detroit Lakes, MN 56501-2840 - Phone
- (218) 844-9730
- NPI assigned
- Aug 12, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 305800 | MN | Primary |
Addresses
Primary practice location
921 8TH St SE
Detroit Lakes, MN 56501-2840
Mailing address
921 8TH Street Southeast
Detroit Lakes, MN 56501-4219
Phone (218) 844-9730
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305800 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633219200000",
"number": "1093480949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "921 8TH STREET SOUTHEAST",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565014219",
"telephone_number": "218-844-9730",
"fax_number": "218-844-7754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "921 8TH ST SE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565012840",
"telephone_number": "218-844-9730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "LOLA",
"middle_name": "MARIE",
"credential": "LADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-12",
"last_updated": "2021-10-03",
"certification_date": "2021-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "305800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.