Healthcare Provider Details

I. General information

NPI: 1417563958
Provider Name (Legal Business Name): RENEWED VISION COUNSELING & CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 BRYTON TRCE
COLUMBIA SC
29210-3642
US

IV. Provider business mailing address

1204 BRYTON TRCE
COLUMBIA SC
29210-3642
US

V. Phone/Fax

Practice location:
  • Phone: 803-238-8681
  • Fax:
Mailing address:
  • Phone:
  • 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: MONIQUE GILCREST
Title or Position: LPC
Credential:
Phone: 803-636-2713