Provider Demographics
NPI:1831864370
Name:RENFROE-MYERS, RENEE ELIZABETH
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ELIZABETH
Last Name:RENFROE-MYERS
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 1:170 SAINT CATHERINES CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5454
Mailing Address - Country:US
Mailing Address - Phone:619-723-3403
Mailing Address - Fax:
Practice Address - Street 1:170 SAINT CATHERINES CT
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-5454
Practice Address - Country:US
Practice Address - Phone:619-723-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190205614103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool