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General NPI Number Information
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NPI Number | 1912435678
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Entity Type | Organization
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Legal Business Name | RENAISSANCE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1025 MAIN ST STE 315
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City | WHEELING
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State | WV
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Zip | 26003-2726
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Country | US
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Telephone | 304-639-8140
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Fax | 304-232-0120
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Provider Business Mailing Address
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Address Line | 1025 MAIN ST STE 315
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City | WHEELING
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State | WV
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Zip | 26003-2726
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Country | US
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Telephone | 304-639-8140
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Fax | 304-232-0120
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | JAMES L HEAGY
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Credential | LCSW
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Telephone | 304-639-8140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 707054
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License Number State | WV
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