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General NPI Number Information
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NPI Number | 1336626795
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Entity Type | Organization
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Legal Business Name | RENEWED RELATIONSHIPS COUNSELING GROUP
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 864 S ROBERTSON BLVD STE 210
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City | LOS ANGELES
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State | CA
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Zip | 90035-1628
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Country | US
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Telephone | 424-302-8227
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Fax |
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Provider Business Mailing Address
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Address Line | 864 S ROBERTSON BLVD STE 210
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City | LOS ANGELES
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State | CA
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Zip | 90035-1628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHANIE MACADAAN
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Credential | LMFT
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Telephone | 424-302-8227
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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 | 88613
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License Number State | CA
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