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General NPI Number Information
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NPI Number | 1235647041
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Entity Type | Organization
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Legal Business Name | RENEWAL COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 4914 FITZHUGH AVE STE 101
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City | RICHMOND
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State | VA
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Zip | 23230
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Country | US
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Telephone | 804-213-2662
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Fax | 888-855-4860
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Provider Business Mailing Address
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Address Line | PO BOX 18362
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City | RICHMOND
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State | VA
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Zip | 23226-8362
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Country | US
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Telephone | 804-213-2662
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Fax | 888-855-4860
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MRS. RASHIKA NELSON WALLACE
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Credential | LCSW
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Telephone | 804-213-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904008492
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License Number State | VA
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