Provider Demographics
NPI:1871038935
Name:RENEWING SPIRIT: AN ANXIETY & WELLNESS PRACTICE, LLC
Entity Type:Organization
Organization Name:RENEWING SPIRIT: AN ANXIETY & WELLNESS PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:WASHINGTON
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:850-443-7948
Mailing Address - Street 1:267 JOHN KNOX RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6611
Mailing Address - Country:US
Mailing Address - Phone:850-443-7948
Mailing Address - Fax:
Practice Address - Street 1:267 JOHN KNOX RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6611
Practice Address - Country:US
Practice Address - Phone:850-443-7948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9460103TC0700X
GAPSY003430103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty