=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598259079
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEWAL COUNSELING AND COACHING ,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2018
-----------------------------------------------------
Last Update Date | 06/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 BROOKWOOD RD
-----------------------------------------------------
City | VENETIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15367-1038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-216-5619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1848 TILTON DR
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15241-2663
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-216-5619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | MRS. SARAH S MITTELMAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 412-216-5619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC005201
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------