Provider Demographics
NPI:1811143753
Name:SANTOS, RENEE MICHELLE (LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MICHELLE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2561 RAYMELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3543
Mailing Address - Country:US
Mailing Address - Phone:508-745-9362
Mailing Address - Fax:
Practice Address - Street 1:4660 VIEWRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1638
Practice Address - Country:US
Practice Address - Phone:619-277-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10467101YM0800X
CA7901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health