Provider Demographics
NPI:1700241411
Name:RENU CHILDREN AND FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:RENU CHILDREN AND FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR/ OW
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:706-284-2382
Mailing Address - Street 1:119 DAVIS RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0200
Mailing Address - Country:US
Mailing Address - Phone:762-994-0882
Mailing Address - Fax:762-994-0885
Practice Address - Street 1:1953 WOODCHUCK WAY
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-7948
Practice Address - Country:US
Practice Address - Phone:706-284-2382
Practice Address - Fax:762-994-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006452261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)