Provider Demographics
NPI:1790736791
Name:FENO, CHRISTINE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:FENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:FERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:616 SHORT SPOON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6412
Mailing Address - Country:US
Mailing Address - Phone:252-903-0234
Mailing Address - Fax:252-977-6242
Practice Address - Street 1:616 SHORT SPOON CIR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6412
Practice Address - Country:US
Practice Address - Phone:252-903-0234
Practice Address - Fax:252-977-6242
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003757Medicaid