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General NPI Number Information
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NPI Number | 1023041043
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Entity Type | Organization
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Legal Business Name | RENAISSANCE THERAPY & FORENSIC COUNSELING CENTER
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 200 EZELL ST
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City | SPARTANBURG
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State | SC
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Zip | 29306
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Country | US
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Telephone | 864-573-5956
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Fax | 864-573-7353
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Provider Business Mailing Address
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Address Line | 200 EZELL ST
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City | SPARTANBURG
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State | SC
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Zip | 29306
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Country | US
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Telephone | 864-573-5956
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Fax | 864-573-7353
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHERYL BLACK HAMAN
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Credential | LPC MAC SAP
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Telephone | 864-573-5956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4251
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License Number State | SC
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