Healthcare Provider Details

I. General information

NPI: 1447933569
Provider Name (Legal Business Name): CHARLOTTE FEATHERSTON COUNSELING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MAIN ST
MAMMOTH SPRING AR
72554-7484
US

IV. Provider business mailing address

PO BOX 1142
MAMMOTH SPRING AR
72554-1142
US

V. Phone/Fax

Practice location:
  • Phone: 870-907-0848
  • Fax: 417-322-6099
Mailing address:
  • Phone: 870-907-0848
  • Fax: 417-322-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLOTTE ANN FEATHERSTON
Title or Position: OWNER
Credential: LPC
Phone: 870-907-0848