Provider Demographics
NPI:1336508878
Name:CURENTON, FAYONA DIANA JAMES (LISW)
Entity Type:Individual
Prefix:
First Name:FAYONA
Middle Name:DIANA JAMES
Last Name:CURENTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:FAYONA
Other - Middle Name:DIANA
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:143-668-7006
Mailing Address - Fax:614-685-3081
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:143-668-7006
Practice Address - Fax:614-685-3081
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 1101015.SUPV1041C0700X
OHI.1101015104100000X
OH151229101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193421Medicaid