Healthcare Provider Details

I. General information

NPI: 1013100502
Provider Name (Legal Business Name): CHRISTINE RENO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MONTLIMAR DR STE 500
MOBILE AL
36609-1794
US

IV. Provider business mailing address

1090 S TAMIAMI TRL
SARASOTA FL
34236-9116
US

V. Phone/Fax

Practice location:
  • Phone: 251-662-9466
  • Fax: 251-207-3351
Mailing address:
  • Phone: 941-363-0878
  • Fax: 716-242-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1767C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: