Provider Demographics
NPI:1225792120
Name:FELDER, SHAVAUGHN (LPMCH, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:SHAVAUGHN
Middle Name:
Last Name:FELDER
Suffix:
Gender:F
Credentials:LPMCH, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27922 ROANOKE RAPIDS LNDG
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-7570
Mailing Address - Country:US
Mailing Address - Phone:302-542-0384
Mailing Address - Fax:302-297-5526
Practice Address - Street 1:27922 ROANOKE RAPIDS LNDG
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-7570
Practice Address - Country:US
Practice Address - Phone:302-542-0384
Practice Address - Fax:302-297-5526
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health