Provider Demographics
NPI:1225758485
Name:RENEWED FOUNDATIONS COUNSELING SERVICES
Entity Type:Organization
Organization Name:RENEWED FOUNDATIONS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:GAYLOR
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-237-9750
Mailing Address - Street 1:105 REDMOND RD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1535
Mailing Address - Country:US
Mailing Address - Phone:706-237-9750
Mailing Address - Fax:
Practice Address - Street 1:105 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1535
Practice Address - Country:US
Practice Address - Phone:706-767-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty