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General NPI Number Information
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NPI Number | 1730456070
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Entity Type | Organization
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Legal Business Name | RENEW FAMILY COUNSELING
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 8613 OLD KINGS RD S SUITE 601
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City | JACKSONVILLE
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State | FL
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Zip | 32217-4807
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Country | US
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Telephone | 912-674-9046
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Fax | 912-673-8853
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Provider Business Mailing Address
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Address Line | 233 GREENBRIAR RD
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City | KINGSLAND
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State | GA
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Zip | 31548-5445
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Country | US
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Telephone | 912-674-9046
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Fax | 912-673-8853
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Authorized Official
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Title or Position | CEO
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Name | DEMETRIUS GONZALEZ
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Credential |
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Telephone | 912-674-9046
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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 |
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License Number State |
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