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General NPI Number Information
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NPI Number | 1558150359
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Entity Type | Organization
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Legal Business Name | SEEDS OF CHANGE COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 7040 LAKELAND AVE N STE 211
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-5616
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Country | US
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Telephone | 763-442-7353
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Fax | 763-441-1308
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Provider Business Mailing Address
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Address Line | 7040 LAKELAND AVE N STE 211
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City | BROOKLYN PARK
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State | MN
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Zip | 55428-5616
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Country | US
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Telephone | 763-442-7353
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Fax | 763-441-1308
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DARLENE SHERICE RILEY
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Credential | LICSW
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Telephone | 763-442-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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