Provider Demographics
NPI:1841846664
Name:RENEW COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:RENEW COUNSELING SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, NCC
Authorized Official - Phone:509-676-6735
Mailing Address - Street 1:750 GEORGE WASHINGTON WAY STE 8
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4247
Mailing Address - Country:US
Mailing Address - Phone:509-676-6735
Mailing Address - Fax:
Practice Address - Street 1:750 GEORGE WASHINGTON WAY STE 8
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4247
Practice Address - Country:US
Practice Address - Phone:509-676-6735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty