Provider Demographics
NPI:1366312639
Name:RENEW FAMILY ASSESSMENT GROUP, LLC
Entity type:Organization
Organization Name:RENEW FAMILY ASSESSMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:SHADARYN
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:678-249-8545
Mailing Address - Street 1:2041 BROOK ENCLAVE TRL
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8312
Mailing Address - Country:US
Mailing Address - Phone:678-249-8545
Mailing Address - Fax:
Practice Address - Street 1:1180 MCKENDREE CHURCH RD STE 107
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5207
Practice Address - Country:US
Practice Address - Phone:678-249-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty