MEDICARE: RENEWED COUNSELING GROUP 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1063374890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED COUNSELING GROUP LLC

Provider Business Mailing Address
First Line	:	5963 EAGLE PT
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-5373
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5963 EAGLE PT
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-5373
Country	:	US
Telephone Number	:	757-284-4890
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	LA-RETHA BROWN
Credential	:
Telephone Number	:	757-284-4890

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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