Mind Renewal LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

MIND RENEWAL LLC

Practice address

1613 Round Hill Cir
Kernersville, NC 27284-7929

Phone

(336) 253-5286

NPI assigned

Oct 1, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Khalid Greenaway, LPC

Title

Ceo

Phone

(336) 253-5286

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538352000000",
    "number": "1710462262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1613 ROUND HILL CIR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847929",
            "telephone_number": "336-253-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1613 ROUND HILL CIR",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847929",
            "telephone_number": "336-253-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIND RENEWAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-01",
        "last_updated": "2018-10-01",
        "status": "A",
        "authorized_official_last_name": "GREENAWAY",
        "authorized_official_first_name": "KHALID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-253-5286",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; 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.