Provider Demographics
NPI:1295565570
Name:KINGSLEY, FONDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:FONDA
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BUTTERFLY
Other - Middle Name:
Other - Last Name:KINGSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3712 VAUCLUSE DR APT 124
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7406
Mailing Address - Country:US
Mailing Address - Phone:616-724-8520
Mailing Address - Fax:
Practice Address - Street 1:3712 VAUCLUSE DR APT 124
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-7406
Practice Address - Country:US
Practice Address - Phone:616-724-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511103481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical