Provider Demographics
NPI:1336505528
Name:PROWS, RENEE MECHELLE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MECHELLE
Last Name:PROWS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 ARSENAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5328
Mailing Address - Country:US
Mailing Address - Phone:910-494-5362
Mailing Address - Fax:910-485-1610
Practice Address - Street 1:916 ARSENAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5328
Practice Address - Country:US
Practice Address - Phone:910-494-5362
Practice Address - Fax:910-485-1610
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional