Provider Demographics
NPI:1144593898
Name:WELLINGTON, FETIMA MARIE (MS, LPC-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:FETIMA
Middle Name:MARIE
Last Name:WELLINGTON
Suffix:
Gender:F
Credentials:MS, LPC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8567
Mailing Address - Country:US
Mailing Address - Phone:315-560-8888
Mailing Address - Fax:
Practice Address - Street 1:310 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332
Practice Address - Country:US
Practice Address - Phone:315-560-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20097101YA0400X
NC10757101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144593898Medicaid