Healthcare Provider Details

I. General information

NPI: 1881306892
Provider Name (Legal Business Name): FELICIA ANN BARNES CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 WINSTON ST
ELIZABETH CITY NC
27909-5829
US

IV. Provider business mailing address

1213 WINSTON ST
ELIZABETH CITY NC
27909-5829
US

V. Phone/Fax

Practice location:
  • Phone: 252-267-5900
  • Fax:
Mailing address:
  • Phone: 252-267-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA18356
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number584881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: