MEDICARE: MR. JUSTIN DANIEL FEASEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	LAC-2208	NC
2	1041C0700X	Clinical Social Worker	C005637	NC

General Provider Information

NPI Number	:	1518029867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN DANIEL FEASEL LCSW

Provider Business Mailing Address
First Line	:	222 N LAFAYETTE ST STE 2
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4450
Country	:	US
Telephone Number	:	704-482-2460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1558 UNION RD STE G
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2215
Country	:	US
Telephone Number	:	980-329-7231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	11/27/2023

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