Provider Demographics
NPI:1730456070
Name:RENEW FAMILY COUNSELING
Entity type:Organization
Organization Name:RENEW FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-674-9046
Mailing Address - Street 1:233 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-5445
Mailing Address - Country:US
Mailing Address - Phone:912-674-9046
Mailing Address - Fax:912-673-8853
Practice Address - Street 1:8613 OLD KINGS RD S
Practice Address - Street 2:SUITE 601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4807
Practice Address - Country:US
Practice Address - Phone:912-674-9046
Practice Address - Fax:912-673-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health