Provider Demographics
NPI:1114561347
Name:RENNER, LORI ANN (LICSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:RENNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BIENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1407
Mailing Address - Country:US
Mailing Address - Phone:251-586-5253
Mailing Address - Fax:
Practice Address - Street 1:29000 US HIGHWAY 98 STE A102
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7203
Practice Address - Country:US
Practice Address - Phone:251-626-5797
Practice Address - Fax:251-626-5798
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4711C101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health