MEDICARE: RECREATING DAWN, 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	:	1518666551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECREATING DAWN, LLC

Provider Business Mailing Address
First Line	:	1397 WARREN RD STE 4
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2570
Country	:	US
Telephone Number	:	216-282-6812
Fax Number	:

Provider Business Practice Location Address
First Line	:	1397 WARREN RD STE 4-5
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2570
Country	:	US
Telephone Number	:	216-282-6812
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, OWNER
Name	:	JOYOUS D WILLIAMS
Credential	:	LPCC, ATR-BC
Telephone Number	:	216-282-6812

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	02/28/2023

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