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Organization
RENEWED LIGHT LLC
Active
Organization
RENEWED LIGHT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS DESIMONE LPC,LCADC (CEO/OWNER)
(856) 508-4925
Entity
Organization
Contact information
Practice address
1225 N BROAD ST STE 1, WEST DEPTFORD, NJ 08096-1203
(856) 508-4925
(856) 861-1216
Mailing address
1225 N BROAD ST STE 1, WEST DEPTFORD, NJ 08096-1203
(856) 508-4925
(856) 861-1216
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/24/2022
Last updated
01/24/2022
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