Provider Demographics
NPI:1003531633
Name:GUPTON, FELICIA SANDERS (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:SANDERS
Last Name:GUPTON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 NC HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:NC
Mailing Address - Zip Code:27551-8913
Mailing Address - Country:US
Mailing Address - Phone:252-226-9787
Mailing Address - Fax:
Practice Address - Street 1:704 S GARNETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4511
Practice Address - Country:US
Practice Address - Phone:252-395-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0169031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical