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Organization
RENEW LIFE GROUP, LLC
Active
Organization
RENEW LIFE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNETTA C RAINER (OWNER)
(910) 291-0078
Entity
Organization
Contact information
Practice address
118 C-JAMES STREET, LAURINBURG, NC 28352-4737
(910) 291-0078
Mailing address
8410 SUTTONVIEW DR, CHARLOTTE, NC 28269-5227
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
208D00000X
General Practice Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
12/08/2011
Last updated
05/20/2016
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