Organization
MIND RENEW,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHOCKIE DERSNO LPC (OWNER)
(404) 953-2501
Entity
Organization
Contact information
Practice address
12211 W BELL RD, SURPRISE, AZ 85378-9521
(404) 953-2501
Mailing address
13807 W COUNTRY GABLES DR, SURPRISE, AZ 85379-8338
(404) 953-2501
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/28/2020
Last updated
07/01/2025
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