African American Survivor Services

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

Legal business name

AFRICAN AMERICAN SURVIVOR SERVICES

Practice address

285 Dale St N Ste 100
Saint Paul, MN 55103-2413

Phone

(612) 306-3416

NPI assigned

Jun 17, 2025

Last updated

Jun 17, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ivan Louis Nelson, CPRSR-FENPI 1023680436

Title

Director/Cprsr

Phone

(612) 306-3416

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ivan Louis Nelson, LADC,CPP

  • Professional Counselor
  • Saint Paul, MN
  • NPI 1023680436
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1750118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750118400000",
    "number": "1386530178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 DALE ST N STE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551032413",
            "telephone_number": "612-306-3416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 DALE ST N STE 100",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551032413",
            "telephone_number": "612-306-3416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFRICAN AMERICAN SURVIVOR SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-17",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "DIRECTOR/CPRSR",
        "authorized_official_telephone_number": "612-306-3416",
        "authorized_official_credential": "CPRSR-FE"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prevention Professional in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Prevention Professional in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.