Healthcare Provider Details

I. General information

NPI: 1790436053
Provider Name (Legal Business Name): RENEW HOLISTIC THERAPY AND COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 LOWCOUNTRY BLVD STE B
MOUNT PLEASANT SC
29464-3091
US

IV. Provider business mailing address

860 LOWCOUNTRY BLVD STE B
MOUNT PLEASANT SC
29464-3091
US

V. Phone/Fax

Practice location:
  • Phone: 706-442-2836
  • Fax:
Mailing address:
  • Phone: 843-693-2517
  • Fax:

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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: BROOKE HILL
Title or Position: OWNER
Credential: LPC
Phone: 843-693-2517