Provider Demographics
NPI:1578999587
Name:PUGH, RENEE NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:NICOLE
Last Name:PUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:NICOLE
Other - Last Name:HOGMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 PROFESSIONAL CT STE 104
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7971
Mailing Address - Country:US
Mailing Address - Phone:919-706-5004
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL CT STE 104
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7971
Practice Address - Country:US
Practice Address - Phone:919-706-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0082511041C0700X
NCC0098391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical