Individual
THEODORE JOHNATHAN RENARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC-I
Contact information
Practice address
118 PLEASANT ST STE 22B, MARBLEHEAD, MA 01945-2344
(617) 680-4094
Mailing address
21 PORTLAND ST APT 2, LYNN, MA 01902-3271
(617) 680-4094
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16000
MA
Other
Enumeration date
02/21/2023
Last updated
02/21/2023
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