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Organization
NEW SALEM METORMORPHOSIS YOUTH PROGRAM
Active
Organization
NEW SALEM METORMORPHOSIS YOUTH PROGRAM
Active
Other names
New Salem Metormorphosis youth program
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HORTENESE NENE JONES BA (PROGRAM ADMINISTRATOR)
(612) 250-8799
Entity
Organization
Contact information
Practice address
2509 BRYANT AVE NORTH, MINNEAPOLIS, MN 55411
(612) 250-8799
(612) 529-9416
Mailing address
2507 BRYANT AVE N, MINNEAPOLIS, MN 55411-2116
(612) 250-8799
(612) 529-9416
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
301674
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/30/2012
Last updated
03/30/2012
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