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General NPI Number Information
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NPI Number | 1790632669
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Entity Type | Organization
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Legal Business Name | RECREATE LIFE, LLC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 5342 OLDEN PORTER RD
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City | PENDLETON
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State | SC
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Zip | 29670-8926
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Country | US
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Telephone | 864-958-0474
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Fax |
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Provider Business Mailing Address
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Address Line | 5342 OLDEN PORTER RD
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City | PENDLETON
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State | SC
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Zip | 29670-8926
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Country | US
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Telephone | 864-958-0474
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAVOLKIA CHANTE MCADAMS
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Credential | LPC, M.ED.
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Telephone | 864-958-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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