Provider Demographics
NPI:1982957056
Name:HISSAM, RENEE DENISE (LPC)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:DENISE
Last Name:HISSAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 QUARTZ WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9844
Mailing Address - Country:US
Mailing Address - Phone:912-355-5938
Mailing Address - Fax:912-355-5954
Practice Address - Street 1:515 E 63RD ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4300
Practice Address - Country:US
Practice Address - Phone:912-355-5938
Practice Address - Fax:912-355-5954
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional