Healthcare Provider Details

I. General information

NPI: 1780793885
Provider Name (Legal Business Name): VIRGINIA CAROL RENFROE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 FROSTWOOD DR 258
HOUSTON TX
77024-2301
US

IV. Provider business mailing address

909 FROSTWOOD DR 258
HOUSTON TX
77024-2301
US

V. Phone/Fax

Practice location:
  • Phone: 713-465-7076
  • Fax: 713-463-5980
Mailing address:
  • Phone: 713-465-7076
  • Fax: 713-463-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19759
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0076931
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: