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General NPI Number Information
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NPI Number | 1265910632
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Entity Type | Organization
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Legal Business Name | RENAISSANCE RELATIONS, INC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 10/22/2022
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Provider Practice Location Address
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Address Line | 540 MCKENZIE AVE
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6720
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Country | US
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Telephone | 404-822-0946
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Fax |
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Provider Business Mailing Address
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Address Line | 540 MCKENZIE AVE
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6720
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Country | US
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Telephone | 404-822-0946
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RASAQ SARUMI
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Credential |
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Telephone | 404-822-0946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 309730029
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number | 309730029
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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