Healthcare Provider Details

I. General information

NPI: 1992665475
Provider Name (Legal Business Name): RENITA JAIN PATEL LPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 VAUX DR
JOHNS CREEK GA
30097-4202
US

IV. Provider business mailing address

512 VAUX DR
JOHNS CREEK GA
30097-4202
US

V. Phone/Fax

Practice location:
  • Phone: 470-223-0060
  • Fax:
Mailing address:
  • Phone: 470-223-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC016156
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC016156
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: