Healthcare Provider Details

I. General information

NPI: 1104469618
Provider Name (Legal Business Name): ANEW LIFE COUNSELING AND CONSULTING GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 CEDAR CENTER DR
TALLAHASSEE FL
32301-4876
US

IV. Provider business mailing address

1266 CEDAR CENTER DR
TALLAHASSEE FL
32301-4876
US

V. Phone/Fax

Practice location:
  • Phone: 850-508-4624
  • Fax:
Mailing address:
  • Phone: 850-508-4624
  • Fax: 850-512-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DRAKE H GUNNING
Title or Position: OWNER
Credential: LCSW
Phone: 850-508-4624