Provider Demographics
NPI:1194236174
Name:HARRIGAN, RENITA (MA, LPC)
Entity type:Individual
Prefix:
First Name:RENITA
Middle Name:
Last Name:HARRIGAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 RED LANE RD STE C5
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8237
Mailing Address - Country:US
Mailing Address - Phone:205-791-5733
Mailing Address - Fax:
Practice Address - Street 1:616 RED LANE RD STE C5
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8237
Practice Address - Country:US
Practice Address - Phone:205-791-5733
Practice Address - Fax:205-358-0034
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3567101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3567OtherLPC
1194236174OtherNPI
AL248618Medicaid
1558934976OtherORGANIZATION NPI