Healthcare Provider Details

I. General information

NPI: 1033902358
Provider Name (Legal Business Name): REDEMPTION ETERNAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 W MOREHEAD STREET SUITE 500 UNIT 225
CHARLOTTE NC
28208
US

IV. Provider business mailing address

1213 W MOREHEAD STREET SUITE 500 UNIT 225
CHARLOTTE NC
28208
US

V. Phone/Fax

Practice location:
  • Phone: 305-771-5652
  • Fax:
Mailing address:
  • Phone: 305-771-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEWAYNE ANTONIO FREEMAN
Title or Position: CEO
Credential:
Phone: 704-631-6995