Organization
779 RIVERSIDE RECOVERY & COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COACH NAKUMBE LPCC, LADC (OWNER / CLINICAL DIRECTOR)
(612) 223-6622
Entity
Organization
Contact information
Practice address
4940 W 77TH ST, EDINA, MN 55435-4805
(612) 223-6622
Mailing address
8014 HIGHWAY 55 UNIT 197, GOLDEN VALLEY, MN 55427-4712
(612) 223-6622
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
00935
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303344
MN
101YM0800X
Mental Health Counselor
00935
MN
101YP2500X
Professional Counselor
00935
MN
103TB0200X
Cognitive & Behavioral Psychologist
00935
MN
103TC0700X
Clinical Psychologist
00935
MN
103TP2701X
Group Psychotherapy Psychologist
00935
MN
261QM0850X
Adult Mental Health Clinic/Center
00935
MN
261QM0855X
Adolescent and Children Mental Health Clinic/Center
00935
MN
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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