| Renewed Therapy Pllc | |
|
105 Inisfree Pl Morrisville NC 27560-7525 | |
| (919) 244-7638 | |
| Not Available |
| Full Name | Renewed Therapy Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 105 Inisfree Pl, Morrisville, North Carolina |
| Authorized Official Name and Position | Beverly Chisholm (OWNER / MANAGER) |
| Authorized Official Contact | 9192447638 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renewed Therapy Pllc 105 Inisfree Pl Morrisville NC 27560-7525 Ph: (919) 244-7638 | Renewed Therapy Pllc 105 Inisfree Pl Morrisville NC 27560-7525 Ph: (919) 244-7638 |
| NPI Number | 1104603455 |
|---|---|
| Provider Enumeration Date | 09/11/2023 |
| Last Update Date | 09/11/2023 |
| Certification Date | 09/11/2023 |
| Medicare PECOS PAC ID | 0042751638 |
|---|---|
| Medicare Enrollment ID | O20240923003378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104603455 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Beverly Chisholm |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770976532 PECOS PAC ID: 1951842541 Enrollment ID: I20240923003488 |
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