Healthcare Provider Details

I. General information

NPI: 1144988080
Provider Name (Legal Business Name): RENEWED INTEGRATIVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 BALM RIVERVIEW ROAD
RIVERVIEW FL
33569
US

IV. Provider business mailing address

10723 BANFIELD DR
RIVERVIEW FL
33579-7781
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-7116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LEVY
Title or Position: OWNER/THERAPIST
Credential: LMHC
Phone: 813-444-7116