Provider Demographics
NPI:1912141805
Name:RENNIE, GINGER ARLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:ARLENE
Last Name:RENNIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:GINGER
Other - Middle Name:ARLENE
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 N CAUSEWAY STE B
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5200
Mailing Address - Country:US
Mailing Address - Phone:386-423-0442
Mailing Address - Fax:386-423-0402
Practice Address - Street 1:221 N CAUSEWAY STE B
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5200
Practice Address - Country:US
Practice Address - Phone:386-423-0442
Practice Address - Fax:386-423-0402
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor