Provider Demographics
NPI:1588489454
Name:RENEW PSYCHOLOGY - REHABILITATION AND NEUROPSYCHOLOGY SERVICES PLLC
Entity type:Organization
Organization Name:RENEW PSYCHOLOGY - REHABILITATION AND NEUROPSYCHOLOGY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CICHA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-295-8335
Mailing Address - Street 1:10258 BAKER BOY DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5897
Mailing Address - Country:US
Mailing Address - Phone:423-295-8335
Mailing Address - Fax:423-295-9318
Practice Address - Street 1:10258 BAKER BOY DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5897
Practice Address - Country:US
Practice Address - Phone:423-295-8335
Practice Address - Fax:423-295-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty