Healthcare Provider Details

I. General information

NPI: 1821993874
Provider Name (Legal Business Name): MRS. TIA BENTIL FELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8154 FOREST HILL AVE STE 2
NORTH CHESTERFIELD VA
23235-3255
US

IV. Provider business mailing address

3363 OAKWOOD CIR
PETERSBURG VA
23805-9335
US

V. Phone/Fax

Practice location:
  • Phone: 804-977-4072
  • Fax: 804-977-4073
Mailing address:
  • Phone: 804-691-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704019648
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: