Healthcare Provider Details

I. General information

NPI: 1811143753
Provider Name (Legal Business Name): RENEE MICHELLE SANTOS LMHC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 02/14/2023
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 VIEWRIDGE AVE
SAN DIEGO CA
92123-1638
US

IV. Provider business mailing address

2561 RAYMELL DR
SAN DIEGO CA
92123-3543
US

V. Phone/Fax

Practice location:
  • Phone: 619-277-9188
  • Fax:
Mailing address:
  • Phone: 508-745-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10467
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: