Healthcare Provider Details

I. General information

NPI: 1508390709
Provider Name (Legal Business Name): RENEWED VISION PERSONAL & CAREER COUNSELING/CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

IV. Provider business mailing address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

V. Phone/Fax

Practice location:
  • Phone: 980-689-4127
  • Fax:
Mailing address:
  • Phone: 980-689-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6401002086
License Number StateMI

VIII. Authorized Official

Name: DR. TERRI LYNN TILFORD
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 980-298-2162