Provider Demographics
NPI:1245560085
Name:RENN, PAUL J III (LCPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:RENN
Suffix:III
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9426 STEWARTOWN RD
Mailing Address - Street 2:2F
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1601
Mailing Address - Country:US
Mailing Address - Phone:301-208-8900
Mailing Address - Fax:301-208-8369
Practice Address - Street 1:9426 STEWARTOWN RD
Practice Address - Street 2:2F
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1601
Practice Address - Country:US
Practice Address - Phone:301-208-8900
Practice Address - Fax:301-208-8369
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDLC2899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional