Organization
RENEWED LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA JO BANKSTON AADC, LADAC, LCSW (OWNER)
(479) 970-6454
Entity
Organization
Contact information
Practice address
115 W H ST STE 151, RUSSELLVILLE, AR 72801-3426
(479) 970-6454
Mailing address
115 W H ST STE 151, RUSSELLVILLE, AR 72801-3426
(479) 970-6454
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
07/17/2024
Last updated
08/14/2025
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