Provider Demographics
NPI:1295242212
Name:VIRGO, FELIESHA (LMSW)
Entity type:Individual
Prefix:
First Name:FELIESHA
Middle Name:
Last Name:VIRGO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:FELIESHA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11275 OAK LN APT 1206
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1494
Mailing Address - Country:US
Mailing Address - Phone:313-258-3350
Mailing Address - Fax:
Practice Address - Street 1:209 S STATE ST
Practice Address - Street 2:
Practice Address - City:GOBLES
Practice Address - State:MI
Practice Address - Zip Code:49055-9405
Practice Address - Country:US
Practice Address - Phone:269-256-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011036901041C0700X
390200000X
MI68011145381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program