Provider Demographics
NPI:1003545013
Name:FENAUD, DENARD (LMSW)
Entity type:Individual
Prefix:
First Name:DENARD
Middle Name:
Last Name:FENAUD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GREATWOOD LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5565
Mailing Address - Country:US
Mailing Address - Phone:772-408-3907
Mailing Address - Fax:678-855-6715
Practice Address - Street 1:101 GREATWOOD LN
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5565
Practice Address - Country:US
Practice Address - Phone:772-408-3907
Practice Address - Fax:678-855-6715
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011595101YM0800X, 104100000X, 1041C0700X
VA0903004043104100000X
MI6851114226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical