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General NPI Number Information
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NPI Number | 1255568242
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Entity Type | Organization
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Legal Business Name | THE LIFE RENEWAL CENTER, INC.
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 7116 SIX FORKS RD. #G
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City | RALEIGH
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State | NC
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Zip | 27615
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Country | US
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Telephone | 919-847-8139
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Fax |
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Provider Business Mailing Address
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Address Line | 7116 SIX FORKS RD. #G
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City | RALEIGH
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State | NC
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Zip | 27615
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Country | US
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Telephone | 919-847-8139
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BRENDA CAROL MONEY
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Credential | LMBT, MMP
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Telephone | 919-847-8139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MB9937
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License Number State | NC
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