| Renewed Life Counseling Services | |
|
10026 University Ave Nw Ste 103 Coon Rapids MN 55448-2213 | |
| (612) 636-9677 | |
| Not Available |
| Full Name | Renewed Life Counseling Services |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 10026 University Ave Nw Ste 103, Coon Rapids, Minnesota |
| Authorized Official Name and Position | Nikisha Lynnette Simmons-maclin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6126369677 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Life Counseling Services 10026 University Ave Nw Ste 103 Coon Rapids MN 55448-2213 Ph: (612) 636-9677 | Renewed Life Counseling Services 10026 University Ave Nw Ste 103 Coon Rapids MN 55448-2213 Ph: (612) 636-9677 |
| NPI Number | 1811452188 |
|---|---|
| Provider Enumeration Date | 01/31/2019 |
| Last Update Date | 01/31/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811452188 | NPI | - | NPPES |
| 1098948 | Other | MN | MINNESOTA DEPARTMENT OF HUMAN SERVICES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Primary |
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