Provider Demographics
NPI:1477382133
Name:RENATA, ALICIA B
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:B
Last Name:RENATA
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CHAMBERS DR NE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1536
Mailing Address - Country:US
Mailing Address - Phone:707-362-5722
Mailing Address - Fax:
Practice Address - Street 1:735 SUNRISE AVE STE 115
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4537
Practice Address - Country:US
Practice Address - Phone:707-362-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health