Provider Demographics
NPI:1710127733
Name:FEATHERSTONE, TINA WESTON (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:WESTON
Last Name:FEATHERSTONE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LAVONE
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:3705 LATROBE DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3705 LATROBE DR
Practice Address - Street 2:SUITE 340
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4824
Practice Address - Country:US
Practice Address - Phone:704-364-3989
Practice Address - Fax:704-364-3974
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCC0074991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6009042Medicaid