Provider Demographics
NPI:1497175814
Name:RENAISSANCE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:RENAISSANCE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-270-6563
Mailing Address - Street 1:704 RUE MARSEILLE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6671
Mailing Address - Country:US
Mailing Address - Phone:757-270-6563
Mailing Address - Fax:
Practice Address - Street 1:704 RUE MARSEILLE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-6671
Practice Address - Country:US
Practice Address - Phone:757-270-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA38988251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health