| Doctor Name: | RENEE WOOTEN |
| NPI Number: | 1003257098 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 4295 Brockton Ave Riverside, CA - 925013446 |
| Business Phone Number: | 9513413786 |
| Business Fax Number: | 9513415316 |
| Mailing Address: | 5870 Arlington Ave, Suite #103 RIVERSIDE |
| State: | CA |
| Postal Code: | 925042037 |
| Phone Number: | 9516836596 |
| Fax Number: | 9516834239 |
| NPI Enumeration Date: | 07/08/2013 |
| NPI Last Update Date: | 07/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |