Provider Demographics
NPI:1356854715
Name:ANEW LLC
Entity type:Organization
Organization Name:ANEW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLESTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA LADC LPCC
Authorized Official - Phone:651-402-4055
Mailing Address - Street 1:445 ETNA ST STE 55
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5848
Mailing Address - Country:US
Mailing Address - Phone:651-756-8561
Mailing Address - Fax:
Practice Address - Street 1:445 ETNA ST STE 55
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5848
Practice Address - Country:US
Practice Address - Phone:651-756-8561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANEW LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-08
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1083233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty