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General NPI Number Information
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NPI Number | 1558938811
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Entity Type | Individual
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Provider Name | RENEE PEREZ LGPC
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Gender | Female
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 17 W MAIN ST
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City | MIDDLETOWN
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State | MD
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Zip | 21769-8080
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Country | US
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Telephone | 410-598-4336
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Fax |
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Provider Business Mailing Address
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Address Line | 308 WINSOME DR
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City | HAMPSTEAD
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State | MD
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Zip | 21074-1717
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Country | US
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Telephone | 410-446-5151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LGP11472
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License Number State | MD
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