Provider Demographics
NPI:1508335415
Name:REJUVENATION HOUSE PLLC
Entity Type:Organization
Organization Name:REJUVENATION HOUSE PLLC
Other - Org Name:REJUVENATION HOUSE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:SWAILS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-377-0099
Mailing Address - Street 1:2800 OLD STAGECOACH LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8234
Mailing Address - Country:US
Mailing Address - Phone:919-377-0012
Mailing Address - Fax:844-856-0856
Practice Address - Street 1:2800 OLD STAGECOACH LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-8234
Practice Address - Country:US
Practice Address - Phone:919-377-0012
Practice Address - Fax:844-856-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty