Healthcare Provider Details

I. General information

NPI: 1528470325
Provider Name (Legal Business Name): RENEW COUNSELING CENTER OF NC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 YADKIN RD STE 100
FAYETTEVILLE NC
28303-3251
US

IV. Provider business mailing address

5114 YADKIN RD STE 100
FAYETTEVILLE NC
28303-3251
US

V. Phone/Fax

Practice location:
  • Phone: 910-779-0454
  • Fax: 910-491-0833
Mailing address:
  • Phone: 910-779-0454
  • Fax: 910-491-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. NORMA IVELISS NEGRON
Title or Position: CEO
Credential: MA
Phone: 910-476-6420