Provider Demographics
NPI:1306116660
Name:WYATT, RENEE ELIZABETH (LPCMH, NCC)
Entity type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:ELIZABETH
Last Name:WYATT
Suffix:
Gender:F
Credentials:LPCMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N SHIPLEY ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3113
Mailing Address - Country:US
Mailing Address - Phone:302-249-7935
Mailing Address - Fax:
Practice Address - Street 1:123 N SHIPLEY ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3113
Practice Address - Country:US
Practice Address - Phone:302-629-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional