Provider Demographics
NPI:1326868159
Name:RENEWED LIFE THERAPEUTIC & SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:RENEWED LIFE THERAPEUTIC & SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAMESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-531-0179
Mailing Address - Street 1:3482 NC HIGHWAY 33 W STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4813
Mailing Address - Country:US
Mailing Address - Phone:252-495-2582
Mailing Address - Fax:
Practice Address - Street 1:3482 NC HIGHWAY 33 W STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4813
Practice Address - Country:US
Practice Address - Phone:252-495-2582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty