Organization
RENAISSANCE COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRENDA G CRUSO (OFFICE MANAGER)
(228) 832-9191
Entity
Organization
Contact information
Practice address
11070 DAVID ST, GULFPORT, MS 39503-3481
(228) 832-9191
(228) 832-9150
Mailing address
11070 DAVID ST, GULFPORT, MS 39503-3481
(228) 832-9191
(228) 832-9150
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2190
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014941
—
MS
Enumeration date
08/08/2006
Last updated
08/22/2020
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