Provider Demographics
NPI:1679723225
Name:FEATHERSTON, CHARLOTTE ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:ANN
Last Name:FEATHERSTON
Suffix:
Gender:F
Credentials:LPC
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 1142
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-1142
Mailing Address - Country:US
Mailing Address - Phone:870-907-0848
Mailing Address - Fax:417-322-6099
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-7484
Practice Address - Country:US
Practice Address - Phone:870-907-0848
Practice Address - Fax:417-322-6099
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0612081101Y00000X
ARP1206072101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR229121719Medicaid
MO490115656Medicaid