Healthcare Provider Details

I. General information

NPI: 1366259616
Provider Name (Legal Business Name): RENEWED & RESTORED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S COLLEGE ST
CHARLOTTE NC
28202-3354
US

IV. Provider business mailing address

1011 SKIPJACK LN
CHARLOTTE NC
28269-4899
US

V. Phone/Fax

Practice location:
  • Phone: 321-226-8803
  • Fax:
Mailing address:
  • Phone: 321-226-8803
  • 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 Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAMARIE STEEN
Title or Position: PARTNER
Credential:
Phone: 321-262-9041