Provider Demographics
NPI:1902586944
Name:RENEW AND REVITALIZE MARRIAGE & FAMILY INSTITUTE
Entity Type:Organization
Organization Name:RENEW AND REVITALIZE MARRIAGE & FAMILY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEBANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-391-8030
Mailing Address - Street 1:7305 BALTIMORE AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3233
Mailing Address - Country:US
Mailing Address - Phone:240-391-8030
Mailing Address - Fax:
Practice Address - Street 1:7305 BALTIMORE AVE STE 307
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3233
Practice Address - Country:US
Practice Address - Phone:240-391-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty