Organization
RENEW LIFE CONCEPTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADRIAKA JACKSON LMHC (MANAGER)
(317) 835-3435
Entity
Organization
Contact information
Practice address
5868 E 71ST ST STE E-630, INDIANAPOLIS, IN 46220-4075
(317) 835-3435
Mailing address
5868 E 71ST ST STE E-630, INDIANAPOLIS, IN 46220-4075
(317) 835-3435
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8973191013
—
IN
Enumeration date
11/06/2019
Last updated
04/26/2023
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