Provider Demographics
NPI:1649054321
Name:RENZE, TERESA ANNE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:RENZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 STUDIO DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-4502
Mailing Address - Country:US
Mailing Address - Phone:402-980-4078
Mailing Address - Fax:
Practice Address - Street 1:7629 PURFOY RD STE 117
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-9550
Practice Address - Country:US
Practice Address - Phone:919-285-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10322A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist