Provider Demographics
NPI:1356106033
Name:FLEENOR, TRINESA LYNN (CSAC)
Entity type:Individual
Prefix:
First Name:TRINESA
Middle Name:LYNN
Last Name:FLEENOR
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MIDVALE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704-7745
Mailing Address - Country:US
Mailing Address - Phone:540-532-7457
Mailing Address - Fax:
Practice Address - Street 1:290 FRONT ROYAL PIKE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-7313
Practice Address - Country:US
Practice Address - Phone:540-546-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)