Organization
LIFE RENEWAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN BYRD (CEO)
(443) 289-8149
Entity
Organization
Contact information
Practice address
10805 HICKORY RIDGE RD, SUITE 103, COLUMBIA, MD 21044-3626
(443) 289-8149
(443) 821-3280
Mailing address
PO BOX 1254, WESTMINSTER, MD 21158-5254
(443) 289-8149
(443) 821-3280
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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