Provider Demographics
NPI:1811353410
Name:WRENN, VIRGINIA L
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:L
Last Name:WRENN
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 1:404 CARTER ST SE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-8552
Mailing Address - Country:US
Mailing Address - Phone:580-226-3295
Mailing Address - Fax:
Practice Address - Street 1:404 CARTER ST SE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-8552
Practice Address - Country:US
Practice Address - Phone:580-226-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health