Provider Demographics
NPI:1275287625
Name:RENNER, DONNA R (LPC)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:R
Last Name:RENNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 NASSAU ST # A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-7022
Mailing Address - Country:US
Mailing Address - Phone:615-406-0464
Mailing Address - Fax:
Practice Address - Street 1:163 NASSAU ST # A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-7022
Practice Address - Country:US
Practice Address - Phone:615-406-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health