Provider Demographics
NPI:1518029867
Name:FEASEL, JUSTIN DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DANIEL
Last Name:FEASEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 N LAFAYETTE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4450
Mailing Address - Country:US
Mailing Address - Phone:704-482-2460
Mailing Address - Fax:
Practice Address - Street 1:1558 UNION RD STE G
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2215
Practice Address - Country:US
Practice Address - Phone:980-329-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAC-2208171100000X
NCC0056371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical