Provider Demographics
NPI:1770893596
Name:HINSON, RENEE COLCLOUGH (PHD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:COLCLOUGH
Last Name:HINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104
Mailing Address - Country:US
Mailing Address - Phone:336-926-1554
Mailing Address - Fax:336-450-4007
Practice Address - Street 1:2594 REYNOLDA RD STE D
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4601
Practice Address - Country:US
Practice Address - Phone:336-978-5324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical