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General NPI Number Information
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NPI Number | 1790636819
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Entity Type | Organization
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Legal Business Name | RENEW AND BLOOM WELLNESS LLC
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 6584 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38138-3687
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Country | US
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Telephone | 901-496-2796
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Fax |
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Provider Business Mailing Address
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Address Line | 6584 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38138-3687
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Country | US
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Telephone | 901-646-0893
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR,CEO
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Name | RUBY BRIANNA WINTERS
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Credential | LPC-MHSP
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Telephone | 901-496-2796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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