Provider Demographics
NPI:1700326881
Name:RENFROE, YAKITTA
Entity Type:Individual
Prefix:
First Name:YAKITTA
Middle Name:
Last Name:RENFROE
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 1:3210 E WOODMEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3591
Mailing Address - Country:US
Mailing Address - Phone:609-442-9722
Mailing Address - Fax:719-960-3286
Practice Address - Street 1:3210 E WOODMEN RD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3591
Practice Address - Country:US
Practice Address - Phone:609-442-9722
Practice Address - Fax:719-960-3286
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013563101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor