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General NPI Number Information
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NPI Number | 1174004881
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS GROUP, LLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 3915 CASCADE RD SW STE T-145
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City | ATLANTA
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State | GA
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Zip | 30331-8520
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Country | US
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Telephone | 404-965-5848
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Fax | 404-965-5848
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Provider Business Mailing Address
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Address Line | PO BOX 42775
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City | ATLANTA
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State | GA
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Zip | 30311-0775
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Country | US
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Telephone | 404-965-5848
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Fax | 404-965-5848
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Authorized Official
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Title or Position | OWNER
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Name | SARAH NYASHA PACE
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Credential | LPC
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Telephone | 404-909-4507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC006062
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License Number State | GA
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