Provider Demographics
NPI:1720248362
Name:HUGHES, RENEE DISTEFANO
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DISTEFANO
Last Name:HUGHES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:D MURPHY
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3333 SILAS CREEK PKWY
Mailing Address - Street 2:SECOND ANNEX
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3013
Mailing Address - Country:US
Mailing Address - Phone:336-718-2507
Mailing Address - Fax:
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:SECOND ANNEX
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional