Provider Demographics
NPI:1902210487
Name:DEWITT, RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 OLD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7479
Mailing Address - Country:US
Mailing Address - Phone:920-851-1034
Mailing Address - Fax:
Practice Address - Street 1:2940 OLD CHURCH RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7479
Practice Address - Country:US
Practice Address - Phone:920-851-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051551041C0700X
WI7466-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical