Healthcare Provider Details

I. General information

NPI: 1679141972
Provider Name (Legal Business Name): RENEWAL, GROWTH, & HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 PATTERSON AVE STE 201
HENRICO VA
23229-6455
US

IV. Provider business mailing address

8545 PATTERSON AVE STE 201
HENRICO VA
23229-6455
US

V. Phone/Fax

Practice location:
  • Phone: 804-901-1570
  • Fax: 804-442-7111
Mailing address:
  • Phone: 804-901-1570
  • Fax: 804-442-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. DREAMEL SPADY
Title or Position: OWNER
Credential: LCSW
Phone: 804-901-1570