Provider Demographics
NPI:1871860791
Name:FELDT, WANDA CHEATHAM (P-LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:CHEATHAM
Last Name:FELDT
Suffix:
Gender:F
Credentials:P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 NC HIGHWAY 24 27
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-8319
Mailing Address - Country:US
Mailing Address - Phone:910-245-7053
Mailing Address - Fax:910-245-9901
Practice Address - Street 1:280 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6350
Practice Address - Country:US
Practice Address - Phone:910-692-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health