Provider Demographics
NPI:1699415216
Name:KOFFA, MARIE NYONNOH-CALY (LADC, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:NYONNOH-CALY
Last Name:KOFFA
Suffix:
Gender:F
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 EWING AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3202
Mailing Address - Country:US
Mailing Address - Phone:612-481-2583
Mailing Address - Fax:
Practice Address - Street 1:3381 GORHAM AVE # A
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55426-4240
Practice Address - Country:US
Practice Address - Phone:952-239-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306196101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)