Provider Demographics
NPI:1326525759
Name:RENEWED STRENGTH, PLLC
Entity Type:Organization
Organization Name:RENEWED STRENGTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNEH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-578-2021
Mailing Address - Street 1:4501 NEW BERN AVE
Mailing Address - Street 2:SUITE 130-#187
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1550
Mailing Address - Country:US
Mailing Address - Phone:919-578-2021
Mailing Address - Fax:
Practice Address - Street 1:152 WIND CHIME CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6433
Practice Address - Country:US
Practice Address - Phone:919-578-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094521041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty