Provider Demographics
NPI:1780793885
Name:RENFROE, VIRGINIA CAROL (MA, LPC)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CAROL
Last Name:RENFROE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:258
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-465-7076
Mailing Address - Fax:713-463-5980
Practice Address - Street 1:909 FROSTWOOD DR
Practice Address - Street 2:258
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2301
Practice Address - Country:US
Practice Address - Phone:713-465-7076
Practice Address - Fax:713-463-5980
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19759101YP2500X
NM0076931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1794851Medicaid
TX9432428OtherPHCS PROVIDER #
TX273705OtherCOMPSYCH PROVIDER #
TX7237LCOtherBLUECROSSBLUESHEILD OF TX