Provider Demographics
NPI:1487775961
Name:FEWELL, IRIS THOMAS (LPC)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:THOMAS
Last Name:FEWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 CABARRUS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7324
Mailing Address - Country:US
Mailing Address - Phone:336-632-0081
Mailing Address - Fax:336-632-0081
Practice Address - Street 1:3408 CABARRUS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7324
Practice Address - Country:US
Practice Address - Phone:336-632-0081
Practice Address - Fax:336-632-0081
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2232101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103354Medicaid