Healthcare Provider Details

I. General information

NPI: 1407345184
Provider Name (Legal Business Name): JESSICA LYNN FELARCA LCSW, LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date: 02/23/2021
Reactivation Date: 03/31/2021

III. Provider practice location address

204 MEADOWS DR
GRAYLING MI
49738-2013
US

IV. Provider business mailing address

204 MEADOWS DR
GRAYLING MI
49738-2013
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-8522
  • Fax:
Mailing address:
  • Phone: 989-348-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW98715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121512
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: