MEDICARE: FLOWING WATERS RENEWAL, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1356293351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOWING WATERS RENEWAL, LLC

Provider Business Mailing Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	678-390-2683
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	678-390-2683
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SONICA YIN LI
Credential	:
Telephone Number	:	678-390-2683

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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