Basic Information
| Provider Information | |||||||||
| NPI: | 1578608311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSON-WEBB | ||||||||
| FirstName: | JONNA | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6172 AIRWAYS BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238921795 | ||||||||
| FaxNumber: | 4237782255 | ||||||||
| Practice Location | |||||||||
| Address1: | 6172 AIRWAYS BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238921795 | ||||||||
| FaxNumber: | 4237783428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 05/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1986 | TN | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 1986 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.