MEDICARE: RECREATE LIFE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1063344224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECREATE LIFE, LLC

Provider Business Mailing Address
First Line	:	5342 OLDEN PORTER RD
Second Line	:
City	:	PENDLETON
State	:	SC
Zip	:	29670-8926
Country	:	US
Telephone Number	:	864-958-0474
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 WOODSIDE AVE
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4221
Country	:	US
Telephone Number	:	864-958-0474
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAVOLKIA CHANTE MCADAMS
Credential	:	LPC, M.ED.
Telephone Number	:	864-958-0474

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “RECREATE LIFE, LLC ” Practice Location

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