Healthcare Provider Details

I. General information

NPI: 1225570740
Provider Name (Legal Business Name): UKNOWN NAKUMBE LPCC, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: COACH NAKUMBE LPCC, LADC

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 W 77TH ST
EDINA MN
55435-4805
US

IV. Provider business mailing address

8014 HIGHWAY 55 APT 197
GOLDEN VALLEY MN
55427-4712
US

V. Phone/Fax

Practice location:
  • Phone: 612-284-2151
  • Fax:
Mailing address:
  • Phone: 612-223-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number303344
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00935
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: