Provider Demographics
NPI:1609394592
Name:FETTY-LOVELL, DANIELLE GRACE (PHD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:GRACE
Last Name:FETTY-LOVELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:GRACE
Other - Last Name:FETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1049 JACK SMITH RD
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-4549
Mailing Address - Country:US
Mailing Address - Phone:423-304-6054
Mailing Address - Fax:
Practice Address - Street 1:6401 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5406
Practice Address - Country:US
Practice Address - Phone:423-893-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9811095-2501103TC1900X
UT98110952501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling