Healthcare Provider Details

I. General information

NPI: 1679401343
Provider Name (Legal Business Name): RENEWING MINDS MENTORING & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 19TH AVE N # 202B
MYRTLE BEACH SC
29577-3249
US

IV. Provider business mailing address

601 19TH AVE N # 202B
MYRTLE BEACH SC
29577-3249
US

V. Phone/Fax

Practice location:
  • Phone: 843-488-0172
  • Fax:
Mailing address:
  • Phone: 843-488-0172
  • Fax: 843-326-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BENNETT
Title or Position: LPC
Credential:
Phone: 843-488-0172