Healthcare Provider Details

I. General information

NPI: 1023940814
Provider Name (Legal Business Name): RIVERS OF RENEWAL COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT STE 306 STE 306
TOLEDO OH
43606-1365
US

IV. Provider business mailing address

3454 OAK ALLEY CT STE 306
TOLEDO OH
43606-1365
US

V. Phone/Fax

Practice location:
  • Phone: 419-318-9661
  • Fax:
Mailing address:
  • Phone: 419-318-9661
  • 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: MR. DUSTIN ERIC SMITH
Title or Position: OWNER
Credential: LISW
Phone: 419-318-9661