Provider Demographics
NPI:1912106568
Name:RENAISSANCE COUNSELING SERVICES,LLC
Entity Type:Organization
Organization Name:RENAISSANCE COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-256-0421
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-0551
Mailing Address - Country:US
Mailing Address - Phone:770-256-0421
Mailing Address - Fax:
Practice Address - Street 1:691 E. COLLEGE AVE.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30031
Practice Address - Country:US
Practice Address - Phone:770-256-0421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health