Organization
REVIVING THERAPY & CONSULTING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL NWALA PHD, LPCC (LICENSED PROFESSIONAL CLINICAL COUN)
(605) 350-5232
Entity
Organization
Contact information
Practice address
2136 FORD PKWY, SAINT PAUL, MN 55116-2850
(605) 350-5232
Mailing address
12460 CORAL SEA ST NE, BLAINE, MN 55449-6232
(605) 350-5232
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
03/03/2025
Last updated
03/03/2025
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