Provider Demographics
NPI:1346327079
Name:KING, RENESE R (CMSW)
Entity Type:Individual
Prefix:MS
First Name:RENESE
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:MRS
Other - First Name:RENESE
Other - Middle Name:R
Other - Last Name:CAVALLERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMSW
Mailing Address - Street 1:3404 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-5801
Mailing Address - Country:US
Mailing Address - Phone:931-220-8040
Mailing Address - Fax:
Practice Address - Street 1:3400 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1237
Practice Address - Country:US
Practice Address - Phone:615-867-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW00000059211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical