| Soul Renewal Family Counseling, Inc. | |
|
7737 Pacific Ave Lemon Grove CA 91945-1740 | |
| (619) 438-0880 | |
| Not Available |
| Full Name | Soul Renewal Family Counseling, Inc. |
|---|---|
| Speciality | Counselor |
| Location | 7737 Pacific Ave, Lemon Grove, California |
| Authorized Official Name and Position | Patricia Johnson Mims (DIRECTOR) |
| Authorized Official Contact | 6194392499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Renewal Family Counseling, Inc. 7737 Pacific Ave Lemon Grove CA 91945-1740 Ph: (619) 439-2499 | Soul Renewal Family Counseling, Inc. 7737 Pacific Ave Lemon Grove CA 91945-1740 Ph: (619) 438-0880 |
| NPI Number | 1295387603 |
|---|---|
| Provider Enumeration Date | 07/15/2019 |
| Last Update Date | 03/08/2024 |
| Certification Date | 03/08/2024 |
| Medicare PECOS PAC ID | 6002252616 |
|---|---|
| Medicare Enrollment ID | O20240306000197 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295387603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Patricia Johnson Mims |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1508418971 PECOS PAC ID: 1456797067 Enrollment ID: I20240306000236 |
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