Individual
CAROL RENNINGER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1960 N DATE ST, T OR C, NM 87901-3701
(505) 267-3088
(505) 267-1747
Mailing address
255 HWY 187, HATCH, NM 87937-0370
(505) 267-3088
(505) 267-1747
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
I05359
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92320848
—
NM
Enumeration date
08/25/2005
Last updated
07/08/2007
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