Provider Demographics
NPI:1750777256
Name:FONTENOT, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6744
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174-6744
Mailing Address - Country:US
Mailing Address - Phone:504-309-7844
Mailing Address - Fax:504-309-7845
Practice Address - Street 1:3324 AUDUBON TRCE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1588
Practice Address - Country:US
Practice Address - Phone:504-834-6771
Practice Address - Fax:504-309-7845
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical