Provider Demographics
NPI:1437379922
Name:FEAGINS, GAIL R (LCSW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:R
Last Name:FEAGINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 CECIL D QUILLEN DR
Mailing Address - Street 2:STE 101
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244-4085
Mailing Address - Country:US
Mailing Address - Phone:423-782-8872
Mailing Address - Fax:
Practice Address - Street 1:373 CECIL D QUILLEN DR
Practice Address - Street 2:STE 101
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244-4085
Practice Address - Country:US
Practice Address - Phone:276-431-1638
Practice Address - Fax:276-431-1639
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000038191041C0700X
VA09040050851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008941041Medicaid
TNP00164012OtherRR MEDICARE
VA008941041Medicaid
VA800002957Medicare ID - Type UnspecifiedMEDICARE VA
TN3924141Medicare ID - Type UnspecifiedCIGNA BRISTOL
S99854Medicare UPIN