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General NPI Number Information
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NPI Number | 1598581118
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Entity Type | Organization
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Legal Business Name | AQUA WELLNESS LLC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 8200 HUMBOLDT AVE S APT 318
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2261
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Country | US
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Telephone | 612-323-9387
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 HUMBOLDT AVE S APT 318
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2261
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Country | US
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Telephone | 612-323-9387
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMUD ABDI
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Credential |
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Telephone | 612-323-9387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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