Healthcare Provider Details

I. General information

NPI: 1174489306
Provider Name (Legal Business Name): FELECIA L CAROTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 KENNINGS DR
MEMPHIS TN
38125-2139
US

IV. Provider business mailing address

3841 KENNINGS DR
MEMPHIS TN
38125-2139
US

V. Phone/Fax

Practice location:
  • Phone: 901-279-9958
  • Fax:
Mailing address:
  • Phone: 901-279-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: