Provider Demographics
NPI:1336508878
Name:CURENTON, FAYONA DIANA JAMES (LISW)
Entity type:Individual
Prefix:
First Name:FAYONA
Middle Name:DIANA JAMES
Last Name:CURENTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:FAYONA
Other - Middle Name:DIANA
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:PO BOX 740013
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0013
Mailing Address - Country:US
Mailing Address - Phone:773-644-3941
Mailing Address - Fax:614-685-3081
Practice Address - Street 1:550 S CHURCH ST STE 14
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3306
Practice Address - Country:US
Practice Address - Phone:864-774-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151229101YA0400X
OHI.1101015104100000X
OHI 1101015.SUPV1041C0700X
SC167671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193421Medicaid