Provider Demographics
NPI:1053071324
Name:INNERGY RENEWAL, LLC
Entity Type:Organization
Organization Name:INNERGY RENEWAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-917-4210
Mailing Address - Street 1:11317 KETTERING CIR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1675
Mailing Address - Country:US
Mailing Address - Phone:301-364-8913
Mailing Address - Fax:
Practice Address - Street 1:11317 KETTERING CIR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1675
Practice Address - Country:US
Practice Address - Phone:301-364-8913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty