Provider Demographics
NPI:1194398651
Name:EWAN, FELICIA LYNNE (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:LYNNE
Last Name:EWAN
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-0508
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:907-822-8803
Practice Address - Street 1:MILE 111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-0508
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:907-822-8803
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor