Provider Demographics
NPI:1508478058
Name:RENEWED WELL-BEING, LLC
Entity Type:Organization
Organization Name:RENEWED WELL-BEING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHARAY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-218-1540
Mailing Address - Street 1:26 ZENITH LOOP
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1270
Mailing Address - Country:US
Mailing Address - Phone:757-218-1540
Mailing Address - Fax:
Practice Address - Street 1:26 ZENITH LOOP
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1270
Practice Address - Country:US
Practice Address - Phone:757-218-1540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA61721228OtherDRIVERS LICENSE