=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063922540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEWED COUNSELING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2017
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2350 MINTON RD STE 103
-----------------------------------------------------
City | WEST MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32904-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-965-3991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2350 MINTON RD STE 103
-----------------------------------------------------
City | WEST MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32904-6603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-426-0359
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SARAI ESCARMENT
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 321-426-0359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------