Provider Demographics
NPI:1174932727
Name:FEATHERSTONE COUNSELING
Entity type:Organization
Organization Name:FEATHERSTONE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:FEATHERSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:803-920-4814
Mailing Address - Street 1:12426 CUMBERLAND COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6812
Mailing Address - Country:US
Mailing Address - Phone:803-920-4814
Mailing Address - Fax:
Practice Address - Street 1:12426 CUMBERLAND COVE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6812
Practice Address - Country:US
Practice Address - Phone:803-920-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC007499251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009042Medicaid