Provider Demographics
NPI:1194438820
Name:BIRCH, RENEE JACOBSEN (LCMHC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JACOBSEN
Last Name:BIRCH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 GUILDBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9613
Mailing Address - Country:US
Mailing Address - Phone:704-970-2471
Mailing Address - Fax:
Practice Address - Street 1:17015 KENTON DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5661
Practice Address - Country:US
Practice Address - Phone:704-970-2471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health