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Organization
SPACE TO BE LLC
Active
Organization
SPACE TO BE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MAIA SHANAE JACKSON MSW, LICSW (PSYCHOTHERAPIST)
(612) 644-8390
Entity
Organization
Contact information
Practice address
2601 HUMBOLDT AVE N, MINNEAPOLIS, MN 55411-2041
(612) 644-8390
Mailing address
2601 HUMBOLDT AVE N, MINNEAPOLIS, MN 55411-2041
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/02/2026
Last updated
07/02/2026
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