Healthcare Provider Details

I. General information

NPI: 1003407917
Provider Name (Legal Business Name): RENEW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10413 SARAH LANDING DR
CHELTENHAM MD
20623-1240
US

IV. Provider business mailing address

10413 SARAH LANDING DR
CHELTENHAM MD
20623-1240
US

V. Phone/Fax

Practice location:
  • Phone: 301-312-2779
  • Fax:
Mailing address:
  • Phone: 301-312-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LEE-ANN HAWKINS
Title or Position: PRESIDENT
Credential: LCPC
Phone: 301-312-2779