Provider Demographics
NPI:1295387603
Name:SOUL RENEWAL FAMILY COUNSELING INC
Entity Type:Organization
Organization Name:SOUL RENEWAL FAMILY COUNSELING INC
Other - Org Name:SOUL RENEWAL FAMILY COUNSELING, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-439-2499
Mailing Address - Street 1:7737 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1740
Mailing Address - Country:US
Mailing Address - Phone:619-439-2499
Mailing Address - Fax:619-439-2455
Practice Address - Street 1:7737 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1740
Practice Address - Country:US
Practice Address - Phone:619-438-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty