MEDICARE: SOPHIA FEASTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-21547	NC

General Provider Information

NPI Number	:	1508246232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA FEASTER

Provider Business Mailing Address
First Line	:	1834 ROWE RD
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-5539
Country	:	US
Telephone Number	:	336-462-6852
Fax Number	:	336-224-2992

Provider Business Practice Location Address
First Line	:	1834 ROWE RD
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-5539
Country	:	US
Telephone Number	:	336-462-6852
Fax Number	:	336-224-2992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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Directions to “ SOPHIA FEASTER ” Practice Location

Language	Start Address	Practice Location

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