Provider Demographics
NPI:1528522778
Name:DAUGHTRY, RENEE FULMER (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:FULMER
Last Name:DAUGHTRY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 HENDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-8223
Mailing Address - Country:US
Mailing Address - Phone:334-372-0346
Mailing Address - Fax:
Practice Address - Street 1:315 N 3NOTCH ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2021
Practice Address - Country:US
Practice Address - Phone:334-372-0346
Practice Address - Fax:256-701-6926
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AL3485101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861983298OtherORGANIZATIONAL NPI