Provider Demographics
NPI:1508089681
Name:ARSENAULT, ADAM DAVID (PSYD, HSP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:ARSENAULT
Suffix:
Gender:M
Credentials:PSYD, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHEROKEE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3886
Mailing Address - Country:US
Mailing Address - Phone:423-264-2394
Mailing Address - Fax:423-214-3415
Practice Address - Street 1:100 CHEROKEE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3886
Practice Address - Country:US
Practice Address - Phone:423-264-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 171M00000X
TN3416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator