Organization
RENEW COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN JOHNSON LOVELACE (BILLING/CREDENTIALING)
(731) 410-7719
Entity
Organization
Contact information
Practice address
108 S 1ST ST, UNION CITY, TN 38261-3802
(731) 592-1987
(731) 681-2823
Mailing address
PO BOX 73, UNION CITY, TN 38281-0073
(731) 592-1987
(731) 681-2823
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q012336
—
TN
05
—
Q017284
—
TN
05
—
Q051441
—
TN
Enumeration date
03/23/2019
Last updated
09/25/2019
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