# RENEWED IMAGE YOUTH & FAMILY SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962277541
- **Authorized official:** DR. SHANIQUA LESESNE LISW-CP (OWNER/PRACTITIONER)
- **Authorized official phone:** (803) 460-6694

## Contact information

- **Practice address:** 15 BROAD ST, SUMTER, SC 29150-4224
- **Practice address phone:** (803) 902-5929
- **Mailing address:** 15 BROAD ST, SUMTER, SC 29150-4224
- **Mailing address phone:** (803) 902-5929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |
| 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