Provider Demographics
NPI:1609563360
Name:RENEWED PROMISE, PLLC
Entity Type:Organization
Organization Name:RENEWED PROMISE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:CLOCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-759-8779
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR STE 497
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:910-759-8779
Mailing Address - Fax:
Practice Address - Street 1:4711 DUNCASTLE RD
Practice Address - Street 2:APT 1E
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314
Practice Address - Country:US
Practice Address - Phone:910-759-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty