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Organization
RENEWED IMAGE YOUTH & FAMILY SERVICES, LLC
Active
Organization
RENEWED IMAGE YOUTH & FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANIQUA LESESNE LISW-CP (OWNER/PRACTITIONER)
(803) 460-6694
Entity
Organization
Contact information
Practice address
15 BROAD ST, SUMTER, SC 29150-4224
(803) 902-5929
Mailing address
15 BROAD ST, SUMTER, SC 29150-4224
(803) 902-5929
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
NULL
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
11/23/2023
Last updated
11/23/2023
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