Provider Demographics
NPI:1134616402
Name:WEBB, FELICIA IMOGEN
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:IMOGEN
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 SAN ANDRES CT APT B
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330-7139
Mailing Address - Country:US
Mailing Address - Phone:808-866-0229
Mailing Address - Fax:
Practice Address - Street 1:2798 SAN ANDRES CT APT B
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330-7139
Practice Address - Country:US
Practice Address - Phone:808-866-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-21
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician