Provider Demographics
NPI:1902152564
Name:JUSTIN D. FEASEL
Entity Type:Organization
Organization Name:JUSTIN D. FEASEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FEASEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:828-303-0875
Mailing Address - Street 1:424 CASTLEBURY CT
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-7854
Mailing Address - Country:US
Mailing Address - Phone:828-303-0875
Mailing Address - Fax:704-978-8579
Practice Address - Street 1:1554 UNION RD STE C
Practice Address - Street 2:SUITE C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5581
Practice Address - Country:US
Practice Address - Phone:828-303-0875
Practice Address - Fax:704-978-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0056371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty