Healthcare Provider Details

I. General information

NPI: 1548758998
Provider Name (Legal Business Name): RENEE OVERBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 RUCKER STREET
STUART VA
24171
US

IV. Provider business mailing address

PO BOX 346
STUART VA
24171-0346
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-3163
  • Fax:
Mailing address:
  • Phone: 276-694-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPGP-333485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: