Provider Demographics
NPI:1447916903
Name:RESTORE AND RENEW COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:RESTORE AND RENEW COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-792-9444
Mailing Address - Street 1:109 LAZY RIV
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-8398
Mailing Address - Country:US
Mailing Address - Phone:916-792-9444
Mailing Address - Fax:
Practice Address - Street 1:401 HUGHES RD STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1144
Practice Address - Country:US
Practice Address - Phone:256-755-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)