Provider Demographics
NPI:1669216446
Name:LOVE RENEWED WELLNESS
Entity type:Organization
Organization Name:LOVE RENEWED WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEORA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:L-IMFT
Authorized Official - Phone:916-216-6968
Mailing Address - Street 1:116 GRANVILLE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-3044
Mailing Address - Country:US
Mailing Address - Phone:916-216-6968
Mailing Address - Fax:
Practice Address - Street 1:116 GRANVILLE ST STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-3044
Practice Address - Country:US
Practice Address - Phone:916-216-6968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty