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General NPI Number Information
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NPI Number | 1568809911
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Entity Type | Individual
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Provider Name | CHRISTY FONTENOT L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 5627 GETWELL RD BLDG C STE. 2
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7328
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Country | US
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Telephone | 662-349-2979
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Fax |
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Provider Business Mailing Address
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Address Line | 324 MEADOW WAY CV
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City | CORDOVA
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State | TN
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Zip | 38018-7309
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Country | US
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Telephone | 901-270-6785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4733
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License Number State | TN
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