Provider Demographics
NPI:1750843074
Name:BELLAS, RENEE SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:SUE
Last Name:BELLAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17371 WAKENDEN
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2238
Mailing Address - Country:US
Mailing Address - Phone:734-334-6411
Mailing Address - Fax:
Practice Address - Street 1:25945 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1808
Practice Address - Country:US
Practice Address - Phone:313-535-6560
Practice Address - Fax:313-535-5266
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801057681104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker