Provider Demographics
NPI:1164686978
Name:RENEWAL COUNSELING CTRS
Entity Type:Organization
Organization Name:RENEWAL COUNSELING CTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:520-886-7022
Mailing Address - Street 1:480 E INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-791-9974
Mailing Address - Fax:520-791-0676
Practice Address - Street 1:480 E INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7016
Practice Address - Country:US
Practice Address - Phone:520-791-9974
Practice Address - Fax:520-791-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC12910251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health