Provider Demographics
NPI:1801461686
Name:RENQUEST, RICHARD ANTON JR (MA, LPC, NCC, ALPS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTON
Last Name:RENQUEST
Suffix:JR
Gender:M
Credentials:MA, LPC, NCC, ALPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3152
Mailing Address - Country:US
Mailing Address - Phone:304-276-9612
Mailing Address - Fax:
Practice Address - Street 1:253 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3152
Practice Address - Country:US
Practice Address - Phone:304-276-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health