Basic Information
| Provider Information | |||||||||
| NPI: | 1003561390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLIGEN | ||||||||
| FirstName: | RENEA | ||||||||
| MiddleName: | BROWN | ||||||||
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| Credential: | LISW-CP/S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2335 GIBBS RD | ||||||||
| Address2: | |||||||||
| City: | JOHNS ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294558020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435136384 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 109 BEE ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294015703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435775011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2022 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 5604 | SC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.