Provider Demographics
NPI:1003947862
Name:HAXTON, RENEE G (MS)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:G
Last Name:HAXTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:GARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4910 CREEKSIDE DR STE D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-4034
Mailing Address - Country:US
Mailing Address - Phone:727-408-0537
Mailing Address - Fax:
Practice Address - Street 1:4910 CREEKSIDE DR STE D
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-4034
Practice Address - Country:US
Practice Address - Phone:727-408-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor