Provider Demographics
NPI:1871250357
Name:RENEW YOU THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:RENEW YOU THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC, LCASA
Authorized Official - Phone:336-892-9945
Mailing Address - Street 1:2123 SOUTHPOINT LN
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NC
Mailing Address - Zip Code:28127-9155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2123 SOUTHPOINT LN
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NC
Practice Address - Zip Code:28127-9155
Practice Address - Country:US
Practice Address - Phone:336-892-9945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1437425113Medicaid