Provider Demographics
NPI:1194041756
Name:GENERATIONS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GENERATIONS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-655-7678
Mailing Address - Street 1:1620 RHODE ISLAND AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4065
Mailing Address - Country:US
Mailing Address - Phone:612-655-7678
Mailing Address - Fax:
Practice Address - Street 1:1595 SELBY AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4528
Practice Address - Country:US
Practice Address - Phone:612-655-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN164751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty