=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063344224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECREATE LIFE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2026
-----------------------------------------------------
Last Update Date | 06/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 WOODSIDE AVE
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29611-4221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-958-0474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5342 OLDEN PORTER RD
-----------------------------------------------------
City | PENDLETON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29670-8926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-958-0474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAVOLKIA CHANTE MCADAMS
-----------------------------------------------------
Credential | LPC, M.ED.
-----------------------------------------------------
Telephone | 864-958-0474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------