Healthcare Provider Details

I. General information

NPI: 1699679134
Provider Name (Legal Business Name): WILLIAM L. FEASTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 MCEVERS BRANCH LNDG
ACWORTH GA
30101-2209
US

IV. Provider business mailing address

247 MCEVERS BRANCH LNDG
ACWORTH GA
30101-2209
US

V. Phone/Fax

Practice location:
  • Phone: 804-245-6977
  • Fax:
Mailing address:
  • Phone: 804-245-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC017305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: