Provider Demographics
NPI:1376817270
Name:FINNICUM, RENEE M (LPCC (CA))
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:FINNICUM
Suffix:
Gender:F
Credentials:LPCC (CA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3905
Mailing Address - Country:US
Mailing Address - Phone:585-899-0513
Mailing Address - Fax:
Practice Address - Street 1:307 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3905
Practice Address - Country:US
Practice Address - Phone:585-899-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2456101YP2500X
IL178.007888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional