Provider Demographics
NPI:1801638861
Name:REAVES, FELICIA SUTTON (LCAS-A)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:SUTTON
Last Name:REAVES
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 PACES FERRY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2195
Mailing Address - Country:US
Mailing Address - Phone:984-364-7098
Mailing Address - Fax:
Practice Address - Street 1:714 WILKINS ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4648
Practice Address - Country:US
Practice Address - Phone:919-938-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-29339101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty