Healthcare Provider Details

I. General information

NPI: 1144157538
Provider Name (Legal Business Name): RIVER COUNSELING MN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 W LAKE ST STE 110
MINNEAPOLIS MN
55408-2554
US

IV. Provider business mailing address

1516 W LAKE ST STE 110
MINNEAPOLIS MN
55408-2554
US

V. Phone/Fax

Practice location:
  • Phone: 612-476-1450
  • Fax:
Mailing address:
  • Phone: 612-476-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: SE-AROM WELDEGIORGIS
Title or Position: OWNER
Credential:
Phone: 204-821-8505