Provider Demographics
NPI:1710251756
Name:FRIESEN, FELICIA H (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:H
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 YAMASEE RD
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-8866
Mailing Address - Country:US
Mailing Address - Phone:704-301-3828
Mailing Address - Fax:
Practice Address - Street 1:4712 LINDA KAY DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-8721
Practice Address - Country:US
Practice Address - Phone:704-301-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health