Organization
SPIRITUAL HEALING LIFE COACH
Active
Other names
Spiritual Healing Sober Living
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY STEVENSON (CEO)
(612) 236-3204
Entity
Organization
Contact information
Practice address
278 7TH ST E, SAINT PAUL, MN 55101-2349
(612) 236-3204
Mailing address
1194 ALBEMARLE ST, SAINT PAUL, MN 55117-4418
(612) 236-3204
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
05/06/2024
Last updated
05/06/2024
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