Healthcare Provider Details

I. General information

NPI: 1033908603
Provider Name (Legal Business Name): REPLENISH AND RENEW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 54TH ST N
WEST PALM BEACH FL
33411-8510
US

IV. Provider business mailing address

12276 54TH ST N
WEST PALM BEACH FL
33411-8510
US

V. Phone/Fax

Practice location:
  • Phone: 732-742-3383
  • Fax:
Mailing address:
  • Phone: 732-742-3383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARYANN SLATER DERNLAN
Title or Position: OWNER
Credential: LMHC
Phone: 732-742-3383