Healthcare Provider Details

I. General information

NPI: 1215869532
Provider Name (Legal Business Name): RENEW AND RESTORE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 NW 2ND AVE APT 109
BOCA RATON FL
33487-3817
US

IV. Provider business mailing address

5700 NW 2ND AVE APT 109
BOCA RATON FL
33487-3817
US

V. Phone/Fax

Practice location:
  • Phone: 732-822-9087
  • Fax:
Mailing address:
  • Phone: 732-822-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELE E GULOTTA
Title or Position: OWNER
Credential: LMHC
Phone: 732-822-9087