Organization
RENEWED LIFE CHRISTIAN COUNSELING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GRANT R HASTY LCSW (CEO/PRESIDENT)
(302) 464-0515
Entity
Organization
Contact information
Practice address
3135 SUMMIT BRIDGE RD, BEAR, DE 19701-2001
(302) 464-0515
(302) 454-7274
Mailing address
34 DALTON DR, NEWARK, DE 19702-2059
(302) 464-0515
(302) 454-7274
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
103TP2701X
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000035733
—
DE
05
—
1972520534
—
DE
Enumeration date
03/06/2012
Last updated
03/06/2012
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