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General NPI Number Information
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NPI Number | 1609043124
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Entity Type | Organization
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Legal Business Name | AFRICAN AMERICAN FAMILY SERVICES
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 1041 SELBY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-6535
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Country | US
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Telephone | 651-642-0021
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Fax | 651-642-0043
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Provider Business Mailing Address
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Address Line | 1041 SELBY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-6535
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Country | US
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Telephone | 651-642-0021
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Fax | 651-642-0043
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LISSA JONES
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Credential |
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Telephone | 612-871-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 805976-2-CDT
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License Number State | MN
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