Self Renew LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

SELF RENEW LLC

Practice address

308 Cumberland Ave
Williamsburg, KY 40769-1292

Phone

(606) 369-3180

NPI assigned

May 4, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Gearheart, CADCNPI 1831457225

Title

President/Ceo

Phone

(606) 369-3180

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Gearheart

  • Addiction (Substance Use Disorder) Counselor
  • Prestonsburg, KY
  • NPI 1831457225
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1013606144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 RIVERSIDE DR",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416537746",
            "telephone_number": "606-369-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 CUMBERLAND AVE",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691292",
            "telephone_number": "606-369-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF RENEW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-04",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "GEARHEART",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "606-369-3180",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Williamsburg, KY
• Providers in Williamsburg, KY by specialty
• Addiction (Substance Use Disorder) Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.