=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972484228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEWED MIND COUNSELING & CONSULTING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 BEAU RIVAGE DR
-----------------------------------------------------
City | CRUMPLER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28617-9679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-877-0317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 BEAU RIVAGE DR
-----------------------------------------------------
City | CRUMPLER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28617-9679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-877-0317
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW HARTZOG
-----------------------------------------------------
Credential | LCMHCA, LCAS
-----------------------------------------------------
Telephone | 828-263-2467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------