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General NPI Number Information
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NPI Number | 1942165048
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Entity Type | Organization
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Legal Business Name | RENEW 360 SUPPORT SERVICES INC
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 2631 LUCENA ST
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City | CHARLOTTE
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State | NC
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Zip | 28206-2109
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Country | US
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Telephone | 704-277-3538
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Fax | 704-277-3538
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Provider Business Mailing Address
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Address Line | 2631 LUCENA ST
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City | CHARLOTTE
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State | NC
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Zip | 28206-2109
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Country | US
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Telephone | 704-277-3538
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Fax | 704-277-3538
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Authorized Official
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Title or Position | OWNER
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Name | LAGINA MCCLINTON
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Credential |
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Telephone | 704-277-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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