Provider Demographics
NPI:1477902716
Name:FAMILY RENEWAL COUNSELING, LLC
Entity Type:Organization
Organization Name:FAMILY RENEWAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:770-540-4639
Mailing Address - Street 1:4595 TOWNE LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5514
Mailing Address - Country:US
Mailing Address - Phone:678-631-7639
Mailing Address - Fax:
Practice Address - Street 1:4595 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:678-631-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty