Organization · NPI-2

779 Riverside Recovery & Counseling Services

Counselor, Addiction (Substance Use Disorder) · Edina, MN

NPI number1437636131
StatusActive
Last updated in NPPESJul 25, 2018

Details

NPI
1437636131
Entity type
Organization (NPI-2)
Legal business name
779 Riverside Recovery & Counseling Services
Organization subpart
No
Enumeration date
Jul 25, 2018
Last updated
Jul 25, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YA0400X Counselor, Addiction (Substance Use Disorder)303344MNYes
101Y00000X Counselor00935MN
101YM0800X Counselor, Mental Health00935MN
101YP2500X Counselor, Professional00935MN
103TB0200X Psychologist, Cognitive & Behavioral00935MN
103TC0700X Psychologist, Clinical00935MN
103TP2701X Psychologist, Group Psychotherapy00935MN
261QM0850X Clinic/Center, Adult Mental Health00935MN
261QM0855X Clinic/Center, Adolescent and Children Mental Health00935MN

Practice location

4940 W 77th St
Edina, MN 55435-4805

Phone 612-223-6622

Mailing address

8014 Highway 55 Unit 197
Golden Valley, MN 55427-4712

Phone 612-223-6622

Authorized official

Coach Nakumbe
Owner / Clinical Director
6122236622

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