Provider Demographics
NPI:1841305406
Name:RENEGAR, LAURA E (LPCC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:RENEGAR
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:6811 BONITA PLAZA NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:228-860-3338
Mailing Address - Fax:480-396-9532
Practice Address - Street 1:4201 CARLISLE BLVD, NE,
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-717-1332
Practice Address - Fax:480-396-9532
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1576101YP2500X
NMCCMH0193751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35273704Medicaid