Renault Van Shirley
Peer Specialist in Louisa, KY. Individual provider (NPI-1).
NPI number1942908306
StatusActive
Last updated in NPPESFeb 15, 2023
Details
- NPI
- 1942908306
- Entity type
- Individual (NPI-1)
- Name
- Renault Van Shirley
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 15, 2023
- Certification date
- Feb 15, 2023
- Last updated
- Feb 15, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 175T00000X | Peer Specialist | – | KY | Yes |
Practice location
125 S Main Cross StLouisa, KY 41230-1065
Phone 606-638-0938
Mailing address
125 S Main Cross StLouisa, KY 41230-1065
Phone 606-638-0938
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