Healthcare Provider Details

I. General information

NPI: 1174237408
Provider Name (Legal Business Name): ANOINTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 QUEBEC AVE N APT 103A
NEW HOPE MN
55428-3383
US

IV. Provider business mailing address

716 COUNTY ROAD 10 NE # 232
BLAINE MN
55434-2331
US

V. Phone/Fax

Practice location:
  • Phone: 612-478-2628
  • Fax:
Mailing address:
  • Phone: 612-478-2628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TA-TANISHA HAWKINS
Title or Position: CEO
Credential: LICSW
Phone: 612-478-2628