MEDICARE: RENEWED THOUGHT THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	103T00000X	Psychologist
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	1041C0700X	Clinical Social Worker
6	101YP2500X	Professional Counselor
7	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154128874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWED THOUGHT THERAPY PLLC

Provider Business Mailing Address
First Line	:	8401 MAYLAND DR # 7117
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	804-302-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 MAYLAND DR # 7117
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	804-302-2569
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	OPEYEMI DADA
Credential	:
Telephone Number	:	240-505-2416

Provider Enumeration Date	:	02/28/2025
Last Update Date	:	12/02/2025

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