Provider Demographics
NPI:1619452216
Name:SINGLETON, FANTASIA TRENELL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:FANTASIA
Middle Name:TRENELL
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 BROGDON CIR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-8040
Mailing Address - Country:US
Mailing Address - Phone:803-968-9792
Mailing Address - Fax:
Practice Address - Street 1:215 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2638
Practice Address - Country:US
Practice Address - Phone:803-435-2124
Practice Address - Fax:803-435-8113
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11958104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker