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Individual
MRS. RENETTA DIANE WEAVER
Active
Individual
MRS. RENETTA DIANE WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW & LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
19932
MD
1041C0700X
Clinical Social Worker
LC50078177
DC
Other
Enumeration date
06/22/2006
Last updated
03/08/2017
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