Provider Demographics
NPI:1215456801
Name:HARVIN, FELECIA
Entity type:Individual
Prefix:
First Name:FELECIA
Middle Name:
Last Name:HARVIN
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 1:231 41ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST.PETE
Mailing Address - State:FL
Mailing Address - Zip Code:33711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:231 41ST ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1111
Practice Address - Country:US
Practice Address - Phone:727-768-5375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician