Provider Demographics
NPI:1508327255
Name:REMADE COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:REMADE COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFINEA
Authorized Official - Middle Name:
Authorized Official - Last Name:REID-BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-801-5020
Mailing Address - Street 1:1820 MEMORIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4693
Mailing Address - Country:US
Mailing Address - Phone:931-801-5020
Mailing Address - Fax:931-614-0880
Practice Address - Street 1:1820 MEMORIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4693
Practice Address - Country:US
Practice Address - Phone:931-801-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health