Provider Demographics
NPI:1851430722
Name:FENTON, CHRISTINE GAIL (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:GAIL
Last Name:FENTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 N SOLOMONS ISLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678
Mailing Address - Country:US
Mailing Address - Phone:410-535-5400
Mailing Address - Fax:410-414-9413
Practice Address - Street 1:975 N SOLOMONS ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-5400
Practice Address - Fax:410-414-9413
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2446101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor