Provider Demographics
NPI:1598302465
Name:RENEE GARRAWAY
Entity Type:Organization
Organization Name:RENEE GARRAWAY
Other - Org Name:NOAH'S ARK COUNSELING & EDUCATIONAL CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, MSW
Authorized Official - Phone:301-922-8659
Mailing Address - Street 1:7315 OLIVE BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6917
Mailing Address - Country:US
Mailing Address - Phone:301-922-8659
Mailing Address - Fax:
Practice Address - Street 1:8101 SANDY SPRING RD STE 100H-1
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3596
Practice Address - Country:US
Practice Address - Phone:301-922-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD754004300Medicaid