Provider Demographics
NPI:1245449925
Name:FLACK, RENAE CHRISTINE (MSW LMSW)
Entity type:Individual
Prefix:MS
First Name:RENAE
Middle Name:CHRISTINE
Last Name:FLACK
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 ALLEN ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195
Mailing Address - Country:US
Mailing Address - Phone:734-785-7704
Mailing Address - Fax:734-785-7734
Practice Address - Street 1:13101 ALLEN ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195
Practice Address - Country:US
Practice Address - Phone:734-785-7704
Practice Address - Fax:734-785-7734
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker