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General NPI Number Information
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NPI Number | 1760366637
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Entity Type | Organization
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Legal Business Name | RENEW COUNSELING CENTER
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 4411 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1615
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Country | US
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Telephone | 616-916-4284
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1615
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Country | US
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Telephone | 616-916-4284
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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 | BRIANNE NOLL
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Credential | M.S, LMFT
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Telephone | 616-916-4284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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