Healthcare Provider Details

I. General information

NPI: 1760201917
Provider Name (Legal Business Name): RENEWIN-MINDS COUNSELING AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 500
LAUREL MD
20708-4245
US

IV. Provider business mailing address

14502 GREENVIEW DR STE 500
LAUREL MD
20708-4245
US

V. Phone/Fax

Practice location:
  • Phone: 301-278-6535
  • Fax:
Mailing address:
  • Phone: 301-278-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: EKUNDAYO K SOGBESAN
Title or Position: PROFESSIONAL COUNSELOR
Credential:
Phone: 301-278-6538