Provider Demographics
NPI:1972263465
Name:RELEASE RESTORE REDEFINE COUNSELING LLC
Entity Type:Organization
Organization Name:RELEASE RESTORE REDEFINE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-750-8906
Mailing Address - Street 1:4115 COLUMBIA ROAD
Mailing Address - Street 2:SUITE 5 #344
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0419
Mailing Address - Country:US
Mailing Address - Phone:706-750-8906
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA ROAD
Practice Address - Street 2:BLDG 11, SUITE A
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-750-8906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty