=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447125570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLFULL RIVER COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2025
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5329 48TH AVE S UNIT 128
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55417-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-243-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5329 48TH AVE S UNIT 128
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55417-3701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-243-5337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NEFERTITI KHEMET GOUDJAYI
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 916-271-6797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------