MEDICARE: REDEEM WELLNESS CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1235873639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDEEM WELLNESS CENTER

Provider Business Mailing Address
First Line	:	3077 N MAIN ST STE 201
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-1735
Country	:	US
Telephone Number	:	910-275-5766
Fax Number	:	866-990-0668

Provider Business Practice Location Address
First Line	:	3077 N MAIN ST STE 201
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-1735
Country	:	US
Telephone Number	:	910-275-5766
Fax Number	:	866-990-0668

Authorized Official
Title or Position	:	OWNER
Name	:	ROBYN ANN MIRASSOU
Credential	:	LCMHC
Telephone Number	:	910-275-5766

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	04/22/2022

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Directions to “REDEEM WELLNESS CENTER ” Practice Location

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