Provider Demographics
NPI:1528862760
Name:RENEWED PEACE PLLC
Entity type:Organization
Organization Name:RENEWED PEACE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-674-0447
Mailing Address - Street 1:PO BOX 31542
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28231-1542
Mailing Address - Country:US
Mailing Address - Phone:704-674-0447
Mailing Address - Fax:
Practice Address - Street 1:201 N MCDOWELL ST UNIT 31542
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28231-0125
Practice Address - Country:US
Practice Address - Phone:704-674-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty