Healthcare Provider Details

I. General information

NPI: 1922956366
Provider Name (Legal Business Name): RENEWED GRACE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MABLE NELL RD
VAN BUREN AR
72956-2964
US

IV. Provider business mailing address

1210 MABLE NELL RD
VAN BUREN AR
72956-2964
US

V. Phone/Fax

Practice location:
  • Phone: 479-806-3237
  • Fax:
Mailing address:
  • Phone: 479-806-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHAWNDA ELAINE WEAR
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 479-806-3237