Provider Demographics
NPI:1538851977
Name:ASAM COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:ASAM COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR & SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DIEUDONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASAMBANG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LADC, LPCC, LSC
Authorized Official - Phone:763-221-3506
Mailing Address - Street 1:13500 GROVE DR
Mailing Address - Street 2:1591
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311
Mailing Address - Country:US
Mailing Address - Phone:763-221-3506
Mailing Address - Fax:
Practice Address - Street 1:9150 ZANZIBAR LN N APT 210
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1674
Practice Address - Country:US
Practice Address - Phone:763-221-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty