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General NPI Number Information
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NPI Number | 1790504165
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Entity Type | Organization
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Legal Business Name | RENAISSANCE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 1212 N WOLFE ST
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City | BALTIMORE
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State | MD
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Zip | 21213-3303
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Country | US
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Telephone | 718-813-7185
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Fax |
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Provider Business Mailing Address
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Address Line | 750 CONCOURSE CIRCLE #103/PMB#303
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City | MIDDLE RIVER
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State | MD
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Zip | 21220
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Country | US
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Telephone | 240-617-1274
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FELITA ANANE
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Credential | LCSW-C
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Telephone | 443-442-7249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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