Provider Demographics
NPI:1497263073
Name:RENEW THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:RENEW THERAPEUTIC SERVICES, LLC
Other - Org Name:RTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:BEAUVOIR
Authorized Official - Last Name:MCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LICSW
Authorized Official - Phone:301-717-7274
Mailing Address - Street 1:12913 VICTORIA HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3017
Mailing Address - Country:US
Mailing Address - Phone:301-717-7274
Mailing Address - Fax:
Practice Address - Street 1:3327 SUPERIOR LN STE 206
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1941
Practice Address - Country:US
Practice Address - Phone:301-717-7274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty