Provider Demographics
NPI:1730852245
Name:MITTELMEIER, RENAE NICOLE (LGPC, NCC)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:NICOLE
Last Name:MITTELMEIER
Suffix:
Gender:F
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S OLD GLEBE RD APT 105
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1757
Mailing Address - Country:US
Mailing Address - Phone:814-240-9944
Mailing Address - Fax:
Practice Address - Street 1:1818 N ST NW STE 315
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-2594
Practice Address - Country:US
Practice Address - Phone:202-573-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00858101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor