Provider Demographics
NPI:1710462262
Name:MIND RENEWAL LLC
Entity Type:Organization
Organization Name:MIND RENEWAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-253-5286
Mailing Address - Street 1:1613 ROUND HILL CIR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7929
Mailing Address - Country:US
Mailing Address - Phone:336-253-5286
Mailing Address - Fax:
Practice Address - Street 1:1613 ROUND HILL CIR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7929
Practice Address - Country:US
Practice Address - Phone:336-253-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty