Provider Demographics
NPI:1174004881
Name:RENEW WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:RENEW WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:NYASHA
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-909-4507
Mailing Address - Street 1:PO BOX 42775
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-0775
Mailing Address - Country:US
Mailing Address - Phone:404-965-5848
Mailing Address - Fax:404-965-5848
Practice Address - Street 1:3915 CASCADE RD SW STE T-145
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8520
Practice Address - Country:US
Practice Address - Phone:404-965-5848
Practice Address - Fax:404-965-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty