Provider Demographics
NPI:1396441416
Name:RENEW YOUR MIND WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:RENEW YOUR MIND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-350-3015
Mailing Address - Street 1:9091 SNOWDEN RIVER PKWY # 1316
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1657
Mailing Address - Country:US
Mailing Address - Phone:443-690-2272
Mailing Address - Fax:
Practice Address - Street 1:5501 TWIN KNOLLS RD STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3260
Practice Address - Country:US
Practice Address - Phone:443-690-2272
Practice Address - Fax:855-450-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty