Provider Demographics
NPI:1073796231
Name:ALBEA, RENETTA S (LCSW)
Entity Type:Individual
Prefix:
First Name:RENETTA
Middle Name:S
Last Name:ALBEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 TELECOM DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3495
Mailing Address - Country:US
Mailing Address - Phone:731-686-9383
Mailing Address - Fax:731-686-9384
Practice Address - Street 1:5120 TELECOM DR
Practice Address - Street 2:SUITE A
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3495
Practice Address - Country:US
Practice Address - Phone:731-686-9383
Practice Address - Fax:731-686-9384
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical