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General NPI Number Information
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NPI Number | 1104603455
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Entity Type | Organization
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Legal Business Name | RENEWED THERAPY PLLC
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 105 INISFREE PL
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City | MORRISVILLE
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State | NC
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Zip | 27560-7525
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Country | US
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Telephone | 919-244-7638
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Fax |
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Provider Business Mailing Address
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Address Line | 105 INISFREE PL
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City | MORRISVILLE
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State | NC
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Zip | 27560-7525
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Country | US
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Telephone | 919-244-7638
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Fax |
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Authorized Official
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Title or Position | OWNER / CLINICAL DIRECTOR
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Name | BEVERLY CHISHOLM
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Credential | LCMHCS
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Telephone | 919-244-7638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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