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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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