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General NPI Number Information
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NPI Number | 1528470325
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Entity Type | Organization
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Legal Business Name | RENEW COUNSELING CENTER OF NC LLC
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 2212 HOPE MILLS RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4228
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Country | US
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Telephone | 910-779-0454
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Fax | 910-491-0833
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Provider Business Mailing Address
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Address Line | 2212 HOPE MILLS RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4228
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Country | US
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Telephone | 910-779-0454
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Fax | 910-491-0833
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. NORMA IVELISS NEGRON
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Credential | MA, LPCA, LCAS,
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Telephone | 910-779-0454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-026-954
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License Number State | NC
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