Provider Demographics
NPI:1205571106
Name:GARDNER, FENNISHA (LCSW)
Entity type:Individual
Prefix:
First Name:FENNISHA
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23010 BLACKSTONE PARK RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3973
Mailing Address - Country:US
Mailing Address - Phone:907-980-9665
Mailing Address - Fax:
Practice Address - Street 1:23010 BLACKSTONE PARK RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3973
Practice Address - Country:US
Practice Address - Phone:907-980-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCSWS11691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical