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General NPI Number Information
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NPI Number | 1326868159
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Entity Type | Organization
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Legal Business Name | RENEWED LIFE THERAPEUTIC & SUPPORTIVE SERVICES
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3482 NC HIGHWAY 33 W STE B
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City | GREENVILLE
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State | NC
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Zip | 27834-4813
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Country | US
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Telephone | 252-495-2582
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Fax |
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Provider Business Mailing Address
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Address Line | 3482 NC HIGHWAY 33 W STE B
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City | GREENVILLE
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State | NC
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Zip | 27834-4813
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Country | US
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Telephone | 252-495-2582
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | SHAMESA TEEL
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Credential |
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Telephone | 252-531-0179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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