MEDICARE: RECALIBRATE & ELEVATE COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1164179800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECALIBRATE & ELEVATE COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	3170 SKINNER MILL RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-5012
Country	:	US
Telephone Number	:	706-309-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 SKINNER MILL RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-5012
Country	:	US
Telephone Number	:	706-309-0800
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR/CEO
Name	:	TENDRA L STATOM
Credential	:	M.ED., LPC, NCC
Telephone Number	:	706-309-0800

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	05/30/2022

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