Provider Demographics
NPI:1164004438
Name:MARCOUX, RENEE
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:MARCOUX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 MANAWA LN
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8522
Mailing Address - Country:US
Mailing Address - Phone:973-534-0414
Mailing Address - Fax:
Practice Address - Street 1:1118 SAM NEWELL RD STE D1
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5162
Practice Address - Country:US
Practice Address - Phone:704-426-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12262A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist