Provider Demographics
NPI:1912629361
Name:RENKE, MICHAEL BENJAMIN (CADC-T)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:RENKE
Suffix:
Gender:M
Credentials:CADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 RAVEN TRL NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1515
Mailing Address - Country:US
Mailing Address - Phone:770-695-3406
Mailing Address - Fax:
Practice Address - Street 1:1290 KENNESTONE CIR STE 109
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6009
Practice Address - Country:US
Practice Address - Phone:770-744-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)