Organization
RENEW WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALISA WILLIAMS LCSW (OWNER)
(208) 912-4011
Entity
Organization
Contact information
Practice address
1281 E IRON EAGLE DR, EAGLE, ID 83616-6599
(208) 912-4011
Mailing address
5650 N DALSPRING AVE, BOISE, ID 83713-1315
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/29/2021
Last updated
02/17/2021
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