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General NPI Number Information
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NPI Number | 1982265690
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Entity Type | Organization
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Legal Business Name | RENEW COUNSELING LLC
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 210 W SAND BANK RD STE 5
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City | COLUMBIA
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State | IL
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Zip | 62236-1044
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Country | US
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Telephone | 314-477-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 632 AUTUMN RISE LN
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City | COLUMBIA
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State | IL
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Zip | 62236-2867
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Country | US
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Telephone | 314-477-1125
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | HEIDI B DONALD
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Credential | MSW, LCSW
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Telephone | 314-477-1125
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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 |
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License Number State |
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