Provider Demographics
NPI:1083398879
Name:RENFROE, MARCIE CHAUNE
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:CHAUNE
Last Name:RENFROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:CHAUNE
Other - Last Name:RENFROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4045 NAPIER AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2182
Mailing Address - Country:US
Mailing Address - Phone:478-390-6206
Mailing Address - Fax:
Practice Address - Street 1:4045 NAPIER AVE APT C
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2182
Practice Address - Country:US
Practice Address - Phone:478-390-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006766104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker