Provider Demographics
NPI:1093095093
Name:RENUSCH, JESSIKA BETH (MA, CADC)
Entity Type:Individual
Prefix:MS
First Name:JESSIKA
Middle Name:BETH
Last Name:RENUSCH
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:BETH
Other - Last Name:RENUSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:751 E GRAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207
Mailing Address - Country:US
Mailing Address - Phone:313-922-2222
Mailing Address - Fax:866-287-5710
Practice Address - Street 1:751 E GRAND BLVD.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-922-2222
Practice Address - Fax:866-287-5710
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)