Provider Demographics
NPI:1962831107
Name:AFIYA SPIRITUAL LIFE CENTER, LLC
Entity Type:Organization
Organization Name:AFIYA SPIRITUAL LIFE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CEASER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:651-260-5419
Mailing Address - Street 1:6009 WAYZATA BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1223
Mailing Address - Country:US
Mailing Address - Phone:651-260-5419
Mailing Address - Fax:
Practice Address - Street 1:6009 WAYZATA BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1223
Practice Address - Country:US
Practice Address - Phone:651-260-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty