Healthcare Provider Details

I. General information

NPI: 1235873639
Provider Name (Legal Business Name): REDEEM WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3077 N MAIN ST STE 201
HOPE MILLS NC
28348-1735
US

IV. Provider business mailing address

3077 N MAIN ST STE 201
HOPE MILLS NC
28348-1735
US

V. Phone/Fax

Practice location:
  • Phone: 910-275-5766
  • Fax: 866-990-0668
Mailing address:
  • Phone: 910-275-5766
  • Fax: 866-990-0668

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBYN ANN MIRASSOU
Title or Position: OWNER
Credential: LCMHC
Phone: 910-275-5766