Provider Demographics
NPI:1992802169
Name:PETTY, FELICIA M (REGISTERED COUNSELOR)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:M
Last Name:PETTY
Suffix:
Gender:F
Credentials:REGISTERED COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E DIVISION ST TRLR 47
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4728
Mailing Address - Country:US
Mailing Address - Phone:360-424-7925
Mailing Address - Fax:360-419-3505
Practice Address - Street 1:1100 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4209
Practice Address - Country:US
Practice Address - Phone:360-419-3547
Practice Address - Fax:360-419-3505
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00029875101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor