Provider Demographics
NPI:1366259616
Name:RENEWED & RESTORED LLC
Entity type:Organization
Organization Name:RENEWED & RESTORED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-262-9041
Mailing Address - Street 1:1011 SKIPJACK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4899
Mailing Address - Country:US
Mailing Address - Phone:321-226-8803
Mailing Address - Fax:
Practice Address - Street 1:615 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3354
Practice Address - Country:US
Practice Address - Phone:321-226-8803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty