Provider Demographics
NPI:1639663420
Name:FORTNER, WHITENEY (LCSW)
Entity Type:Individual
Prefix:
First Name:WHITENEY
Middle Name:
Last Name:FORTNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:FORTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6110 SHALLOWFORD RD STE B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4615 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3826
Practice Address - Country:US
Practice Address - Phone:731-335-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health