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1801594528
THEODORE JOHNATHAN RENARD
MARBLEHEAD, MA
NPI
1801594528
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: MA 16000)
Enumeration Date
2023-02-21
Last Update Date
2023-02-21
Business Address
THEODORE JOHNATHAN RENARD LADC-I
118 PLEASANT ST STE 22B
MARBLEHEAD, MA 01945-2344
Phone number: 617-680-4094
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Mailing Address
THEODORE JOHNATHAN RENARD LADC-I
21 PORTLAND ST APT 2
LYNN, MA 01902-3271
Phone number: 617-680-4094
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