Provider Demographics
NPI:1225570740
Name:NAKUMBE, COACH (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:COACH
Middle Name:
Last Name:NAKUMBE
Suffix:
Gender:M
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 HIGHWAY 55 APT 197
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4712
Mailing Address - Country:US
Mailing Address - Phone:612-234-1044
Mailing Address - Fax:
Practice Address - Street 1:6040 EARLE BROWN DR STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-9902
Practice Address - Country:US
Practice Address - Phone:612-865-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303344101YA0400X
MN00935101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)