Renaissance Counseling Services,LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

RENAISSANCE COUNSELING SERVICES,LLC

Practice address

691 E. College Ave.
Decatur, GA 30031

Phone

(770) 256-0421

NPI assigned

Jul 13, 2007

Last updated

Jul 13, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Quincy Preston-Clark

Title

Ceo

Phone

(770) 256-0421

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Derrick Christopher Lake, LCSW

  • Clinical Social Worker
  • Decatur, GA
  • NPI 1982879490
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184284800000",
    "number": "1912106568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300310551",
            "telephone_number": "770-256-0421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "691 E. COLLEGE AVE.",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "30031",
            "telephone_number": "770-256-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE COUNSELING SERVICES,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-13",
        "last_updated": "2007-07-13",
        "status": "A",
        "authorized_official_last_name": "PRESTON-CLARK",
        "authorized_official_first_name": "QUINCY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-256-0421",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Decatur, GA
• Providers in Decatur, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.