Healthcare Provider Details

I. General information

NPI: 1407610132
Provider Name (Legal Business Name): RENEWING PATHS COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 S MAIN ST STE 206
WAKE FOREST NC
27587-9391
US

IV. Provider business mailing address

2006 S MAIN ST STE 206
WAKE FOREST NC
27587-9391
US

V. Phone/Fax

Practice location:
  • Phone: 919-671-6438
  • Fax:
Mailing address:
  • Phone: 919-671-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEREMY PHAN
Title or Position: OWNWER/THERAPIST
Credential: MA, LCMHC, NCC
Phone: 919-671-6438