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General NPI Number Information
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NPI Number | 1295242212
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Entity Type | Individual
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Provider Name | FELIESHA VIRGO LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 209 S STATE ST
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City | GOBLES
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State | MI
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Zip | 49055-9405
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Country | US
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Telephone | 269-256-5073
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Fax |
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Provider Business Mailing Address
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Address Line | 11275 OAK LN APT 1206
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City | VAN BUREN TWP
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State | MI
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Zip | 48111-1494
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Country | US
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Telephone | 313-258-3350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801103690
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801114538
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License Number State | MI
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