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General NPI Number Information
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NPI Number | 1316265143
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Entity Type | Organization
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Legal Business Name | RENEW COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 455 OLD LONG RIDGE RD
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City | STAMFORD
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State | CT
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Zip | 06903-1112
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Country | US
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Telephone | 187-784-7363
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Fax |
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Provider Business Mailing Address
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Address Line | 8 WAKEMAN RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-5120
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Country | US
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Telephone | 203-255-5078
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. DUANE KELLOGG
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Credential |
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Telephone | 18778473639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001291
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License Number State | CT
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