Organization
RENEWED LIFE COUNSELING, LLC
Active
Organization
RENEWED LIFE COUNSELING, LLC
Active
Other names
Renewed Life Counseling Services
Organization subpart
No
Provider details
NPI number
Authorized official
NIKISHA LYNNETTE SIMMONS-MACLIN LADC (EXECUTIVE DIRECTOR)
(612) 636-9677
Entity
Organization
Contact information
Practice address
10026 UNIVERSITY AVE NW STE 103, COON RAPIDS, MN 55448-2213
(612) 636-9677
Mailing address
10026 UNIVERSITY AVE NW STE 103, COON RAPIDS, MN 55448-2213
(612) 636-9677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1098948
MINNESOTA DEPARTMENT OF HUMAN SERVICES
MN
Enumeration date
01/31/2019
Last updated
01/31/2019
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