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General NPI Number Information
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NPI Number | 1124721089
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Entity Type | Organization
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Legal Business Name | RENEW HOPE COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 3464 FAIRBURN RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2926
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Country | US
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Telephone | 678-687-1224
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 BLUFF CREEK OVERLOOK
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-8107
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Country | US
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Telephone | 678-687-1224
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. INGRID RICHARDSON
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Credential | LPC
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Telephone | 678-687-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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