Provider Demographics
NPI:1588091532
Name:REJUVENATED MINDS, PLLC
Entity type:Organization
Organization Name:REJUVENATED MINDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:RACHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:919-800-0757
Mailing Address - Street 1:3719 BENSON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7324
Mailing Address - Country:US
Mailing Address - Phone:919-800-0757
Mailing Address - Fax:866-626-1755
Practice Address - Street 1:3719 BENSON DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7324
Practice Address - Country:US
Practice Address - Phone:919-800-0757
Practice Address - Fax:866-626-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC134272363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty