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General NPI Number Information
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NPI Number | 1790070928
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Entity Type | Individual
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Provider Name | CHRISTINE ANN RENUART LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 8998 LANE LORAINE
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City | ROGERS
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State | AR
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Zip | 72756-7891
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Country | US
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Telephone | 479-366-2846
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Fax |
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Provider Business Mailing Address
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Address Line | 3310 OAK VISTA DRIVE
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City | PORT ORANGE
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State | FL
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Zip | 32128
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Country | US
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Telephone | 479-354-2455
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2420C
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License Number State | AR
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