| Organization Name: | WAKE RENEWAL COUNSELING, PLLC |
| NPI Number: | 1205276599 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEISHA HINTON BRYAN (OWNTER/THERAPIST) |
| Mailing Address: | 1008 Big Oak Ct Ste F Knightdale |
| State: | NC US |
| Postal Code: | 275456566 |
| Phone Number: | 9195209392 |
| Fax Number: | 9192611675 |
| NPI Enumeration Date: | 07/01/2013 |
| NPI Last Update Date: | 07/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C006619 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |