Provider Demographics
NPI:1194232694
Name:RENEW YOUR HEART AND MIND, LLC
Entity type:Organization
Organization Name:RENEW YOUR HEART AND MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:SHOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-344-7519
Mailing Address - Street 1:23321 COUNTRY LIVING RD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-2850
Mailing Address - Country:US
Mailing Address - Phone:302-344-7519
Mailing Address - Fax:
Practice Address - Street 1:23321 COUNTRY LIVING RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-2850
Practice Address - Country:US
Practice Address - Phone:302-344-7519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2017103313261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)