| Renew Counseling Center Of Nc Llc | |
|
2212 Hope Mills Rd Fayetteville NC 28304-4228 | |
| (910) 779-0454 | |
| (910) 491-0833 |
| Full Name | Renew Counseling Center Of Nc Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2212 Hope Mills Rd, Fayetteville, North Carolina |
| Authorized Official Name and Position | Norma Iveliss Negron (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9107790454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Counseling Center Of Nc Llc 2212 Hope Mills Rd Fayetteville NC 28304-4228 Ph: (910) 779-0454 | Renew Counseling Center Of Nc Llc 2212 Hope Mills Rd Fayetteville NC 28304-4228 Ph: (910) 779-0454 |
| NPI Number | 1528470325 |
|---|---|
| Provider Enumeration Date | 05/28/2014 |
| Last Update Date | 10/10/2017 |
| Medicare PECOS PAC ID | 7315224680 |
|---|---|
| Medicare Enrollment ID | O20170516000477 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528470325 | NPI | - | NPPES |
| 6111783 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHL-026-954 (North Carolina) | Primary |
| Provider Name | Deidre Newkirk Murphy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295251973 PECOS PAC ID: 1456626340 Enrollment ID: I20171003004702 |
| Provider Name | Juanita Massol |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659664324 PECOS PAC ID: 5698030203 Enrollment ID: I20180601001005 |
| Provider Name | Telisa Pharris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871944124 PECOS PAC ID: 4082964069 Enrollment ID: I20180912003457 |
| Provider Name | Beakie Colon Rivera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083135131 PECOS PAC ID: 1254761265 Enrollment ID: I20200415000569 |
| Provider Name | Lauren Hailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548895451 PECOS PAC ID: 1850721580 Enrollment ID: I20200421002382 |
| Provider Name | Sandra Gail Kolb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790452076 PECOS PAC ID: 2163829508 Enrollment ID: I20210927003443 |
| Provider Name | Kimberly Lynette Mcallister |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265194682 PECOS PAC ID: 4385039379 Enrollment ID: I20220309001134 |
| Provider Name | Madeline A Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720714512 PECOS PAC ID: 2769854322 Enrollment ID: I20230207002858 |
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