Individual
MRS. NIKISHA LYNNETTE SIMMONS-MACLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
10026 UNIVERSITY AVE NW STE 103, COON RAPIDS, MN 55448-2213
(612) 636-9677
Mailing address
10732 ILEX ST NW, COON RAPIDS, MN 55448-6508
(612) 636-9677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304191
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1098948
MINNESOTA DEPARTMENT OF HUMAN SERVICES
MN
01
—
304191
MINNESOTA BOARD OF BEHAVIOR HEALTH
MN
Enumeration date
02/06/2016
Last updated
01/30/2019
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