Provider Demographics
NPI:1114761327
Name:RENAISSANCE SOMATIC COUNSELING
Entity type:Organization
Organization Name:RENAISSANCE SOMATIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-270-3370
Mailing Address - Street 1:529 TRUETT DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5218
Mailing Address - Country:US
Mailing Address - Phone:850-270-3370
Mailing Address - Fax:
Practice Address - Street 1:2509 BARRINGTON CIR STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6801
Practice Address - Country:US
Practice Address - Phone:850-270-3370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty