Provider Demographics
NPI:1508199688
Name:FELDHAUS, WILLA J (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WILLA
Middle Name:J
Last Name:FELDHAUS
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 1:1011 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-0906
Mailing Address - Country:US
Mailing Address - Phone:910-526-6510
Mailing Address - Fax:
Practice Address - Street 1:1011 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-0906
Practice Address - Country:US
Practice Address - Phone:910-526-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical