Provider Demographics
NPI:1568809911
Name:FONTENOT, CHRISTY (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MEADOW WAY CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7309
Mailing Address - Country:US
Mailing Address - Phone:901-270-6785
Mailing Address - Fax:
Practice Address - Street 1:5627 GETWELL RD BLDG C
Practice Address - Street 2:STE. 2
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7328
Practice Address - Country:US
Practice Address - Phone:662-349-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical