Provider Demographics
NPI:1003113648
Name:TACKETT, RENITA JOYCE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:RENITA
Middle Name:JOYCE
Last Name:TACKETT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LITTLE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501
Mailing Address - Country:US
Mailing Address - Phone:606-639-2969
Mailing Address - Fax:
Practice Address - Street 1:146 CHURCH OF CHRIST WAY
Practice Address - Street 2:FORDS BRANCH CHURCH OF CRIST
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-8944
Practice Address - Country:US
Practice Address - Phone:606-213-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1031101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor