Healthcare Provider Details

I. General information

NPI: 1659144673
Provider Name (Legal Business Name): RENU ACP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9729 OLDE MILBROOKE WAY
GLEN ALLEN VA
23060-9220
US

IV. Provider business mailing address

9729 OLDE MILBROOKE WAY
GLEN ALLEN VA
23060-9220
US

V. Phone/Fax

Practice location:
  • Phone: 804-652-9509
  • Fax: 866-622-7868
Mailing address:
  • Phone: 804-652-9509
  • Fax: 866-622-7868

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CIERRA RENEE CAREY
Title or Position: OWNER/OPERATOR
Credential:
Phone: 804-652-9509