Provider Demographics
NPI:1215113634
Name:BOND, RENEE MICHELLE (LICENSED MARRIAGE FA)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MICHELLE
Last Name:BOND
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE FA
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:MICHELLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 FAIRVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370
Mailing Address - Country:US
Mailing Address - Phone:209-536-2000
Mailing Address - Fax:209-536-2002
Practice Address - Street 1:175 FAIRVIEW LANE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-536-2000
Practice Address - Fax:209-536-2002
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA106091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator