Healthcare Provider Details

I. General information

NPI: 1558983080
Provider Name (Legal Business Name): RENITA NICHELLE HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 PHOENIX BLVD
ATLANTA GA
30349-5754
US

IV. Provider business mailing address

1000 WHITLOCK AVE NW STE 320
MARIETTA GA
30064-5449
US

V. Phone/Fax

Practice location:
  • Phone: 678-335-9010
  • Fax:
Mailing address:
  • Phone: 678-469-7434
  • 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:
Title or Position:
Credential:
Phone: